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RELEASE AND HOLD HARMLESS AGREEMENT FOR
SAN BERNARDINO COUNTY

I, ____________________________________________________________________, fully understand that
(Last) (First) (Middle)
San Bernardino County is a self-insured public entity pursuant to Government Code Section 990.4. I understand that
the County's program of self-Insurance does not provide medical payments in the event that I am Injured while
participating in the event described below. In the event that I am injured as a result of the act or omission of any
party, including the County, it’s Contractor's, Agents and Co-sponsors of the event and their agents, Volunteers,
Officers and Employees (hereafter collectively referred to as "Sponsors*), my ability to recover special or general
damages (as defined by Civil Code) will be limited in that I will not be entitled to recover special and general damages
from the Sponsors.
Notwithstanding the above acknowledgement, I understand that my participation in the 5K Run/Walk at the San
Bernardino County Picnic (hereafter referred to as 'Event"), including transportation to and from said Event, may be
hazardous and exposes me to the risk of personal injury, death or property damage. I hereby acknowledge I am
voluntarily participating in this event and expressly agree to assume these risks of injury or harm and release the
Sponsors from liability for injury, illness, death, or property damage resulting from the Event.
In further consideration for being allowed to participate in the Event, I hereby agree, for myself, my heirs,
administrators, executors and assigns, that I will Indemnify and hold harmless the Sponsors and their successors
and/or assigns from any and all claims, including claims for Workers’ Compensation benefits, damages, demands,
actions or suits arising out of or in connection with my participation in the Event brought by any third party.
I HAVE CAREFULLY READ THIS RELEASE AND HOLD HARMLESS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS.
I AM AWARE THAT IT IS A FULL RELEASE OF ALL LIABILITY AND SIGN IT OF MY OWN FREE WILL.

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Participant Name - Please Print Employee ID (If Applicable)

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Participant Signature Date

(IF PARTICIPANT IS A MINOR OR SUBJECT TO A GUARDIANSHIP, PLEASE COMPLETE THE FOLLOWING PARAGRAPH)
I, ___________________________________________________________, am the parent and/or Legal Guardian of
(Last) (First) (Middle)
I fully understand that participation in the 5K Run/Walk at the San Bernardino County Picnic (hereafter referred to as
"Event”) exposes participants to the risk of personal injury, death or property damage. I hereby acknowledge that
______________________________is voluntarily participating in this Event with my express permission. As parent
and/or Legal Guardian, I expressly agree to assume any such risks and each of the releases discussed above to this
participation.
In consideration for being permitted to participate in the Event, I hereby release and forever discharge the Sponsors,
for any Injury, death or damage to or loss of personal property arising out of or connection with me or my minor
child(s) ______________________________ participation in the Event from whatever cause, including the Sponsor’s
active or passive negligence or any other participants in the Event.

PHOTO/MEDIA RELEASE FORM

As part of its branding/marketing strategy, San Bernardino County uses publications, websites, social media and
other forms of media to promote San Bernardino in various manners, including as the Employer of Choice. This
release provides San Bernardino County, its representatives and employees, the right to use your name, photos, or
video, including the taking/filming of photos/videos related to the marketing efforts of the department.
By signing below, you certify and understand that your information as described above may be used for promotional
purposes.

PARTICIPANT CERTIFICATION

I authorize San Bernardino County to use my information or my minor child's information, if applicable, as described
above. I understand that I will not be compensated nor rewarded for the use of this Information.
□ I have read and understand the above

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Participant Name - Please Print Employee ID (If Applicable)

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Participant Signature Date