Volunteer Sign-up Form

SHASTA MUD RUN- MAY 7, 2022                                                                                                                                        BibNumber:

PARTICIPANT WAIVER, RELEASE OF LIABILITY                                                                                                   LastName(Print):

CONENANT NOT TO SUE & IMAGE RELEASE                                                                                                               EventLocation: Hawes Farms, Anderson, CA

Inconsiderationofbeingallowedtoparticipateinanywayintheabovereferenced Shasta Mud Runcompetition(s),race(s),related events(the“Event”)and/oractivities,I,theundersigned,acknowledge,covenantandagreethat:

1.Shasta Mud Run Event may involve hostile environments that might include extreme heat or cold, snow, mud, extreme changes in elevation and water. Some of the activities include runs, military style obstacles, going through pipes, traversing cargo nets, climbing walls, and traversing muddy areas. In summation, the Event is a hazardous activity that presents a serious physical and mental challenge to participants.

2.AFTEROPPORTUNITYTOFULLYINFORMMYSELFABOUTTHEEVENT,I KNOWINGLYANDFREELYASSUMEANDACCEPTALLSUCHRISKS, BOTHKNOWNANDUNKNOWN,andassumefullresponsibilityandallrisksformyparticipationintheEvent;

3.I voluntarilyagreetocomplywiththestatedandcustomarytermsandconditionsfor participation.If,however,Iobserveanyunusualand/orsignificanthazard duringmypresenceor participation,Iwillremovemyselffromparticipationandbringsuchhazardtotheattentionof thenearestofficial;

4.I,formyselfandonbehalfof myheirs,assigns,personalrepresentativesand/ornextof kin,foreverWAIVE,RELEASE,DISCHARGEandCOVENANTNOTTO SUEYOUTH VIOLENCE PREVENTION COUNCIL OF SHASTA COUNTY doing business as YOUTH OPTIONS SHASTA(YOS); EDDIE AXNER CONSTRUCTION; HAWES FAMILY RANCH/FARM; all event and photograph sponsors and advertisers; governmental bodies and/or municipal agencies whose property and/or personnel are used; and any and all parent, subsidiary or affiliate companies, licensees, officers, directors, partners, board members, supervisors, employees, contractors, insurers, agents, volunteers, equipment suppliers and representatives of any of the foregoing (collectively,the"Releasees"),WITHRESPECTTO ANYANDALLINJURY,DISABILITY,DEATH,and/orlossor damagetopersonor property,incurredbymeinconnectionwithparticipationintheEvent.I further agreetoindemnify,defendandholdharmlessReleaseesfromanyloss,liability,cost,claim, ordamagesarisingfrommyparticipationinorassociationwithactivities andeventsorganizedandsponsoredbytheYOS,Eddie Axner Construction, Hawes Family Ranch/Farm, or any person or organization which are in any way connectedwiththeEvent.

5.Iattestandverifythat,unlessotherwiseindicatedbelow,I amover18yearsof age,amfreefromallillnesses,injuriesanddefectsthatcouldinterferewithmysafe participationintheEventandthatIamphysicallyfitandsufficientlytrainedtoparticipateinallactivitiesassociatedwiththeEvent.Myparticipationinactivitiesand eventsorganizedorsponsoredbythe Youth Options Shastaisentirelyvoluntary.

6.Iconsenttoadministrationof firstaidandothermedicaltreatmentintheeventof injuryorillnessandherebyreleaseandindemnifyReleaseesfromanyandall liabilityor claimsarisingoutof suchtreatment.

7.TheReleaseesreservetheright,in theirsoleandabsolutediscretion,topostpone,cancel,ormodifytheeventduetoweatherconditions,ActsofGodorotherfactors beyondthecontrolof theReleaseesthatmightaffectthehealthand/orsafetyof theparticipants.Norefundswillbegranted.

8.I irrevocablygrantunlimitedpermissiontoReleasees,touse,reproduce,sellanddistributeanyandallphotographs,images,videotapes,motionpictures,recordings, oranyotherdepictionof anykindof meor of myparticipationintheEventorrelatedactivityforanylegitimatepurposeinperpetuityandI understandthatI shallnot be entitledtoanycompensationtherefore.

9.IherebyirrevocablyandabsolutelygrantpermissiontotheReleaseesto film,videotapeandrecordgratistheperformanceof theabovenamedparticipant(referredto hereinas“I”,“me”,“my”)intheEventandsubsequentlytotelecast,sell,distributeandotherwiseutilizethesameinwhatevermannerReleaseesshalldeem appropriate.SuchpermissionshallincludegrantingtheunlimitedandirrevocablerighttoReleasees,withoutcompensationof anykindtome,touse,reproduceor broadcast,myname,nickname,image,likeness,voice,photograph,signaturefacsimile,andbiographicalinformationinconnectionwiththeEventwithout compensationofanykindtome.I acknowledgethatReleaseesandtheirrepresentativesshallhavetheunlimitedrightthroughouttheworldtocopyright,use,reuse, publish,republish,broadcastandotherwisedistributedepictionsof orinformationaboutmeandalloranyportionoftheEventinwhichImayappearonanyandall radio,network,cableandlocaltelevisionprogramsandinanyprintmaterialsandinanyotherformatormedia(includingelectronicmedia)nowknownorhereinafter devisedinperpetuityandwithoutcompensationtome.InconsiderationandinreturnforbeingallowedtoparticipateintheEvent,Ireleaseandagreenottosuethe ReleaseesfromallpresentandfutureclaimsregardingmyparticipationintheEventsthatmaybemadebyme,myfamily,estateheirs,orassigns.

IHAVEREADTHISRELEASEOFLIABILITYANDASSUMPTIONOFRISKAGREEMENT,FULLYUNDERSTANDITSTERMS, UNDERSTANDTHATIHAVEGIVENUPSUBSTANTIALRIGHTSBYSIGNINGIT,ANDSIGNITFREELYANDVOLUNTARILY WITHOUTANYINDUCEMENT.

ParticipantName(PRINT):                                                                                                                                                                           

Signature                                                                                                                                     Date                                                                     

EMERGENCYCONTACT(required)   Name                                                                                                                                                       Phone_________________________

MINORS:IFUNDER18–SIGNATURE  OFPARENTORGUARDIAN(required)

The undersigned, ______________________________________, hereby certifies, warrants and represents that I am the legal parent or guardian of _______________________________________, the signer of the above Release (the Participant), and that after fully informing myself regarding the nature and risks of the Event, I give my permission for Participant to participate in the same and by my signature below I fully ratify, accept, and agree to all of the terms of the above Release both for myself individually and as legal parent or guardian of the Participant.

Signature                                                                                                                   Relationshiptominor                                                          ______ Date _________________