3rd Annual Adventure Race
3rd Annual Adventure Race
Lisa Brown
Tuesday, April 03, 2018

Come join us at the 3rd Annual NSCISD Adventure Race on April 28th.

Waiver and Release of Liability for Participants

Participant Information

Waiver and Release of Liability for Participants

Name: ___________________________________   Phone: ___________________

Email:_____________________________  Team Name: ______________________

Team Members:          1-2 o                        3-5 o 
                        6-more o

Date of Birth (if under 18): ______________________

Emergency Contact Name: ________________________   Phone: _____________

Relation: __________________________

In consideration of being permitted to participate in the Nixon-Smiley Adventure Race, I agree to assume all risks inherent in participation in such program, whether they are apparent to me or not. I certify that I am in good physical health and fit to participate. Nevertheless, I acknowledge that participation carries an inherent risk of injury to my person and damage to my property. I hereby waive and release, for myself and for my heirs and assigns, any and all claims, cause of action, or liabilities which may hereafter accrue against Nixon-Smiley CISD Employees, Clubs, Student Associations, Grade Organizations and Sponsors, volunteers, officers, directors, the City of Nixon, and any and all sponsors, their representatives and successors, that may arise as a result of my participation in the Nixon-Smiley Adventure Race, including any and all claims for personal injuries caused by the Nixon-Smiley Adventure Race.

Furthermore, I hereby grant full permission to any and all of the foregoing to use any photographs, motion pictures, recordings, or any other record of these events for any legitimate purpose, including commercial advertising, without monetary payment to me. (This information is protected by the Privacy Act.)

Signature of Participant: ________________________________________

Date: ________________

This section is to be read and signed by parent/legal guardian if Participant is a minor: As the parent/legal guardian of the above-named Participant, I hereby waive and release on behalf of my child, any and all claims, and causes of action, or liabilities which may hereafter accrue against Nixon-Smiley CISD Employees, Clubs, Student Associations, Grade Organizations and Sponsors, volunteers, officers, directors, the City of Nixon, and any and all sponsors, their representatives and successors, that may arise as a result of my child’s participation in the Nixon-Smiley Adventure Race, including any and all claims for personal injuries caused by the Nixon-Smiley Adventure Race. In addition, I accept full responsibility for the care and supervision of my child during the above-described runs.

Signature of Parent/Legal Guardian: ______________________________________

Date: ________________


For more information contact: Lisa Brown at (830) 582-1536