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No emails or URLs allowed

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No emails or URLs allowed

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{{ 'PRIMARY-PHONE' | translate}}

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{{ 'EMAIL' | translate}}

{{ 'EMAIL-CONFIRM' | translate}}

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{{ 'PLEASE-PROVIDE-VALUE' | translate}}

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{{ 'DATA-PRIVACY' | translate}}

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2016 PARTICIPATION WAIVER  
By signing, you agree, warrant and covenant as follows:   In consideration of your accepting this entry, I, the undersigned, intending to be legally bound, hereby, for myself, my family, my heirs, executors, and administrators, forever waive, release & discharge any and all rights & claims for damages & causes of suit or action known or unknown, that I may have against St. Luke’s Regional Medical Center, Ltd., St. Luke’s $10,000 Weight Loss Challenge, volunteers, sponsors, contributors, and organizers & their officers, directors, employees, agents & representatives, successors, & assigns, for any and all injuries that may be suffered by me in this program.
  

I attest that I am physically able to complete this program and am aware of the dangers & precautions that must be taken when taking part in a Weight Loss Challenge. I also agree to abide by any decision of an appointed medical official relative to my ability to safely continue or complete the program. I further assume and will pay my own medical & emergency expenses in the event of an accident, illness, personal injury or other incapacity regardless of fault or whether I have authorized such expenses.
  

Further, I hereby grant full permission to use any photographs, videotapes, motion pictures, recording, or any other record of this program for any legitimate purpose at any time. If I am a winner, I authorize St. Luke’s to release my name and weight loss information. My registration serves as my permission to receive Challenge communications only. I understand that my information will not be sold or released to outside parties and I have the option to decline Challenge communications by calling or sending written notice to the Challenge Office.

REFUND POLICY: Please read all of the requirements and rules of the Challenge prior to registering as all registrations are NON-REFUNDABLE and non-transferable to next year’s event, NO exceptions. This policy stays in effect whether you are injured, have an unexpected business or family emergency, pregnancy, etc.  There are NO exceptions.  

I also hereby affirm that I am eighteen (18) years of age, 
understand the 2016 Challenge Rules, Regulations and Recommendations, and have read this waiver carefully & understand it.
 


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{{ 'SALES_FEE' | translate}} : {{cart.totalSales | currency:"$":currency.decimal}}
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{{ 'PROCESSING_FEE' | translate }} : {{cart.lotteryFee | currency:"$":currency.decimal}}
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{{ 'NO-PAYMENT-REQUIRED' | translate }}
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{{ 'REQUIRED' | translate }} {{ 'PAYMENT-NAME-MIN-LENGTH' | translate }}

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{{ 'EXPIRATION' | translate }}
{{ 'SECURITY-CODE' | translate }}
{{ 'POSTAL-CODE' | translate }}
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{{ 'REQUIRED' | translate }} {{ 'PAYMENT-NAME-MIN-LENGTH' | translate }}

{{ 'CARD-NUMBER' | translate }}

{{ 'REQUIRED' | translate }} {{ 'INVALID-CREDIT-CARD-NUMBER' | translate }}

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