I understand that participating in the
Mayhem Run may be a strenuous and hazardous activity containing extreme
obstacles. These obstacles include, but are not limited to, steep hills, mud
pits, fallen logs and a true swamp area. I am physically capable of
participating in the Mayhem Run.
I assume all risks associated with
participating in the Mayhem Run, including but not limited to falls, contact
with other participants, injuries related to completing obstacles, any defects
or the conditions of the premises, and effects caused by the weather.
I assume the risk of any and all
injuries, damages or loss, regardless of severity, that my minor child/ward or
I may sustain as a result of participation in or observation of the Mayhem
I agree to waive, release and hold
harmless Northwest Iowa Hospital Corporation dba: St. Luke’s Regional Medical Center, St.
Luke’s Health System, dba: UnityPoint Health – St. Luke’s (collectively, “St.
Luke’s”), St. Luke’s Health Foundation of Sioux City dba: St. Luke’s Foundation, St. Luke’s Children’s Miracle
Network, and all entities sponsoring this event from any and all liability for
any injury or damage whatsoever arising from any participation in the free
I understand that to be eligible for a
prize, I must be a registered participant and complete the Mayhem Run including
all obstacles on the course.
grant permission for the use of my name, picture and voice in any broadcast,
telecast, print account or any account in any medium used in connection with
this event or future events of St. Luke’s.
In consideration of the
opportunity to participate in the Mayhem Run, I agree to, release, indemnify,
and agree to hold harmless all groups and persons, including St. Luke’s, their
employees or members and all officials, sponsors, contributors, volunteers,
etc. from any and all liability for any injury or damages whatsoever arising
from any participation in this event. I understand that this event is a
potentially hazardous activity and have read, understand and agree to all of
the information above as well as the attached form: who is under 18
years of age. I have read the above Mayhem Run Waiver and Release of Claims,
Assumption of Risk and Warning of Risk Form and am fully familiar with the
contents thereof. I give permission for the child named above to participate in
the activities of the Mayhem Run, including any special events/activities
described above. In consideration for allowing the participation of the child
in these activities, I hereby consent to the Mayhem Run Waiver and Release of
Claims, Assumption of Risk and Warning of Risk Form above, on behalf of the
child and agree that this Form shall be binding upon me, my family, heirs,
legal representatives, successors, and assigns. I agree to release, indemnify and hold
harmless St. Luke’s from any and all claims for injuries, damages or loss that
my minor child/ward may have or which may accrue to me or my minor child/ward
and arising out of, connected with, or in any way associated with the Mayhem