Chocolate Chase 5k

Please read this form carefully, and be aware that by registering for and participating in this program, or by registering your minor child/ward for participation in this program, you will be waiving your right and/or the rights of your minor child/ward to all claims for injuries you or your minor child/ward might sustain arising out of this program and you will be required to indemnify, hold harmlessand defend the City of Palos Heights of any claims arising out of participation in the above program. As a participant in the program, or as a parent or legal guardian of a participant under 18 years of age, I recognize and acknowledge that there are certain risks ofphysical injury including but not limited to death, damages, or loss and I agree to assume the full risk of injuries which I may sustainas a result of participation in any and all activities associated with this program. I agree to waive and relinquish any claims I may have arising out of, connected with, or in any way associated with the activities of the program. Release from liability: I do hereby fully release and discharge the City of Palos Heights and its officers, agents and employees from all claims from injuries, including death, damage, or loss which I or my minor may incur on account of participation in this program. I further agree to indemnify, hold harmless, and defend the City of Palos Heights and its officers, agents, and employees from any and all claims from injuries, including death, damages, and losses sustained by me or my minor ward/child and arising out of, or connected with, or associated with the activities of the program. In the event of any emergency. I authorize the public entity to secure from any physician, and/or medical personnel any treatment deemed reasonable/necessary for my minor's immediate care and agree that I will be responsible for payment of any and all medical services rendered. I have read, fully understand and agree to the above conditions of participation in the above program.