As a participant in 2019 Tom Pfeifle Memorial Run/Walk, I, for myself, my executor, administrators, heirs, devises and assigns do hereby discharge the Tom Pfeifle Memorial Run/Walk, the event site, their management, their officers, board members, employees, members, sponsors, volunteers, organizers or their representatives, or their successors and all cooperating businesses and organizations from all claims of damages, demands, actions, illnesses, death and causes whatsoever in any matter arising from or growing out of my participation or that of my child in the event. The run/walk participant agrees to indemnify the Tom Pfeifle Memorial Inc. for all fines, fees and expenses incurred as a result of the breach of any contractual obligations of the Run/Walk Participant.

I attest and verify that I am, or my child (under 18), is medically able to participate and assume all risks of participation in this event. I understand that I may be photographed, filmed or videotaped at the event. I hereby irrevocably grant to Tom Pfeifle Memorial Run/Walk, the absolute right and permission to use my likeness and/or voice for any purpose whatsoever, including commercial advertising.

I state that I am physically fit and able to run/walk in the Tom Pfeifle Memorial Run/Walk, I also give my full permission for such first aid as deemed necessary to be provided to me or my child on the premises or prior to transport to a hospital for further treatment.

If I am under the age of 18, my parents have consented to my participation in the Tom Pfeifle Memorial Run/Walk, and have agreed to all of the Run/Walk Participant Terms and Conditions on my behalf.

I understand that the registration fee is a non-refundable in case of withdrawal on my part or cancellation due to inclement weather.

Participant Name: __________________________________ Date: _______________
Participant Signature: ___________________________________________________
Parent or Guardian Signature (if under 18): _____________________________