THE UNIVERSITY OF IOWA
WAIVER AND RELEASE FORM
In consideration for being permitted to participate in the Shelly Bridgewater Dreams Foundation 5K Run/Walk
sponsored by the UI Department of OBGYN/Shelly Bridgewater Dreams Foundation, and to be held in Coralville,
Iowa on July 8, 2017, on behalf of myself, my family, my heirs, and my assigns, I hereby release The University of Iowa;
the Board of Regents, State of Iowa; the State of Iowa, The Shelly Bridgewater Dreams Foundation, and each of their
respective employees, agents and representatives (Releasees) from any and all liability for personal injury, including
death, or property loss or damage suffered by me as a result of, arising out of, or in any way involving my participation in
this event, except to the extent that such liability results directly from the negligence of the University of Iowa or the
Shelly Bridgewater Dreams Foundation, their agents, or their employees.
I acknowledge that I know, understand, and appreciate the inherent risks in participating in a 5K Run/Walk. The risks
may include, but are not limited to; trips/falls; potholes, debris, or other irregularities on the course; contact with other
participants, strollers, wheelchairs and/or animals on the course; risks associated with vehicular traffic on or near the event
route; the effect of weather including extreme temperatures, humidity, wind, and/or rain; bodily injury including, but not
limited to, sprains, strains, cramps, ligament or cartilage damage, blood pressure or cardiac abnormalities; and property
loss or damage. The risks include exacerbation of pre-existing medical conditions. By signing this agreement, I fully
assume the inherent risks associated with this activity, and assert that I am voluntarily participating in the event, and I am
at least eighteen (18) years of age* and fully competent.
I grant the University of Iowa, The Shelly Bridgewater Foundation, and persons acting for or through them the right to
use, reproduce, assign, and/or distribute images, audio and video recordings, and likenesses in any medium whatsoever, of
myself, for the purpose of promoting the University of Iowa, The Shelly Bridgewater Foundation, or for any other lawful
purpose, without payment to me. The University, its successors and assigns shall own all right, title and interest,
including the copyright, to any such image, recording, or likeness.
I hereby release and hold harmless the Board of Regents, State of Iowa; the University of Iowa and the State of Iowa; The
Shelly Bridgewater Dreams Foundation; as well as each of their respective agents and employees from any and all claims,
including but not limited to claims of infringement, damages or remuneration, for invasion of privacy, defamation, or
misappropriation, or otherwise arising from such use.
- By submitting my registration, I certify that I am at least 18 years of age and fully competent. I understand and agree to all
terms of the waiver and release form.I am submitting a registration for my child to participate with me.
- By checking this box and submitting this registration form
I certify that: I am the parent/legal guardian of the participant named on this registration form; I understand and accept the
risks associated with my child’s participation; I understand and agree to all terms of the above.