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ACKNOWLEDGEMENT OF RISK AND WAIVER OF LIABILITY

There is no fee to register for the Florence Neal Cooper Smith 5K.  A donation towards the Florence Neal Cooper Smith Professorship is greatly appreciated.

Please read and acknowledge the risk and waiver liability associated with the walk.

PLEASE NOTE THAT A SIGNED FORM IS REQUIRED FOR EACH PARTICIPANT.

Alternatively, you may download a blank form and email it to factssickle71@gmail.com before the event or bring the completed form(s) to the event.

Read this Acknowledgement of Risk and Waiver of Liability carefully and in its entirety.  It is a binding legal document.  

I know that participating in the Florence Neal Cooper Smith 5k is a potentially hazardous activity and I should not enter and participate unless I am medically able and properly trained.  I acknowledge and assume all risks associated with this event including, but not limited to, falls, contact with other participants, and the condition of the course, including, but not limited to, curbs, cars, uneven pavement, potholes, rocks, and objects on the course surface.  Knowing and appreciating these risks and in consideration of your acceptance of my entry, I hereby for myself, my heirs, representatives or anyone else claiming on my behalf, covenant not to sue, and waive, release, and discharge the F.A.C.T.S. Committee, its volunteers, and sponsors, and anyone else acting for or on behalf the Florence Neal Cooper Smith 5k from any and all claims of liability for death, personal injury, or damage of any kind arising out of my participation in this run.  This Acknowledgement of Risk and Waiver of Liability extends to all claims of every kind whatsoever.  I also consent to emergency treatment in the event of injury or illness.  I grant full permission to the F.A.C.T.S. Committee and/or any person or entity authorized by it to use my name, age, date of birth, finish place and finish time in the public domain.  I further grant full permission for the F.A.C.T.S. Committee to use any photographs, recordings, or any other record of this event for any purpose.  My signature acknowledges that I have read the above waiver, and I agree and accept all terms and conditions set forth herein.

Activity: Florence Neal Cooper Smith 5k

Date: September 20,2025

PLEASE PRINT.

Participant Information

Sex
Male
Female

In signing the Acknowledgement of Risk and Waiver Liability I hereby acknowledge and represent: (a) that I have read this document in its entirety, understand it, and sign it voluntarily; and (b) that this Acknowledgement of Risk and Waiver of Liability is the entire agreement between the parties hereto and its terms are contractual and not a mere recital.

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REQUIRED FOR ALL PARTICIPANTS UNDER 18 YEARS OF AGE: PARENT OR GUARDIAN’S AUTHORIZATION FOR MEDICAL CARE AND CONSENT AGREEMENT.

I certify that I am the parent or legal guardian of the above-named participant in the Florence Neal Cooper Smith 5k. On behalf of myself and my spouse, partner, co-guardian or any other person who claims the participant as a dependent, I have read the above agreement, I understand the contents of this Acknowledgement of Risk and Waiver of Liability, assent to its terms and conditions, and sign this Acknowledgement of Risk and Waiver of Liability of my own free act. I acknowledge that my dependent and I have agreed to the terms and conditions of my dependent’s participation in the Florence Neal Cooper Smith 5k, and I hereby give my consent to participation by my dependent in the Florence Neal Cooper Smith 5k, and to receive medical treatment determined to be necessary. I further agree to hold harmless, indemnify and defend the F.A.C.T.S. Committee from and against all claims, demands or suits that my dependent has or may have.

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