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In consideration of accepting my registration and signing this form, I, for myself, heirs and personal representatives, assume full and complete responsibility for any injury, accident or damage done to my person or party which may occur during my participation in this Georgetown Running Club (GRC) Vern’s No Frills 5k Event or while I am on the premises of this event; and hereby release and hold harmless the sponsors, promoters and all other persons or entities associated with this event from any and all injury, damage or expense suffered by me whether it be caused by my own negligence or any other and all entities associated with this event or events or employees or otherwise. In addition to the absolute and unqualified release from all liability, I hereby represent that I am physically capable of participating in this event, I will conduct myself in a safe and prudent manner while participating in the event and I hereby absolve and hold harmless all and any parties or entities associated with the Georgetown Running Club (GRC) Vern’s No Frills 5k from any injury or damage I may sustain because of any breach of these representations. I hereby consent to and permit emergency treatment in the event of injury or illness while participating in the event. I also hereby give permission to GRC to use my name and any pictures/videos taken of me during the event in any promotional materials, publications or on the Internet.

Initials of athlete 18 years of age or older or parent/legal guardian of minor under 18 years of age or legal guardian of incapacitated and/or mentally challenged person.
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