WAIVER: _____ (initials)

In consideration of being permitted to participate in any way in the Symmes Township 5K Fun Run and Walk (the “Event”) I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue Symmes Township, or its officers, employees, volunteers and agents from liability from any and all claims resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the Event.

INDEMNIFICATION AND HOLD HARMLESS: _____ (initials)

I also agree to INDEMNIFY AND HOLD Symmes Township and its officers, employees, volunteers and agents HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in the Event and to reimburse them for any such expenses incurred.

SEVERABILITY: _____ (initials)

The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement

is intended to be as broad and inclusive as is permitted by the law of the State of Ohio and that if any

portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

PHOTO RELEASE: _____ (initials)

I authorize Symmes Township to use my or my child’s photo in any manner Symmes Township desires, for advertising, display, audio-visual, exhibition or editorial use.

ACKNOWLEDGMENT OF UNDERSTANDING: _____ (initials)

I have read this waiver of liability, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

Print Full Name: ____________________

Signature: _________________________                                            Date: _______________

Parent or Guardian (if participant is under 18): I am the parent or legal guardian of the above-named minor child and, as such, I am authorized to enter into this agreement. I agree that my minor child and I are bound by and subject to the terms of this agreement. I understand that my signature here reflects my agreement to hereby release, waive, discharge, and covenant not to sue Symmes Township or its officers, employees, volunteers and agents from liability from any and all claims resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the Event.

Parent/Guardian Signature: _________________________             Date: _______________