Go BIG for Parkinson’s

THIS RELEASE IS A CONTRACT WITH LEGAL CONSEQUENCES.  READ IT CAREFULLY BEFORE SIGNING. In consideration of being allowed to participate in any way in this event, program, and related activities, I ___________________:

1)      Acknowledge and fully understand that I will be participating in activities that may or may not involve risk of serious injury, permanent disability, property damage and/or death.  These risks may result not only from my own actions, inactions, or negligence, but also from the action, inactions, or negligence of others.  Further, there may be other risks not known to me, or not reasonably foreseeable, such as disability or death.

2)      Assume all the foregoing risks and accept personal responsibility for any damages following any such injury, permanent disability, property damage, or death.

3)      Release, waive, discharge, and covenant not to sue the State of Arizona, the Arizona Board of Regents, Northern Arizona University, their officers, employees and agents, and their heirs, administrators, and executors, from demands, losses, or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of any person or otherwise, for myself and my spouse, if any, and our heirs,  successors, and assigns.

4)      Understand that the State of Arizona, the Arizona Board of Regents, and Northern Arizona University do not provide medical coverage to a participant if injured while participating in the event described above or attendant activities.  Any medical costs incurred as a result of this activity will be my financial responsibility.

5)      ACKNOWLEDGE THAT I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT VOLUNTARILY. 

Additionally, I grant Go BIG for Parkinson's and the NAU PT Department, its representatives and employees the

right to take photographs of me and my property in connection with

Go BIG for Parkinson's. I authorize NAU PT and the APDA, its

assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that NAU Physical Therapy and the APDA may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I have read and understand the above.