--------------------------------------------------------------------------------------

(please complete, then tear off and mail with a $20 check payable to POES)

Release and Waiver

I understand that during my participation in the Piney Orchard Elementary 5K Run/Walk, (“the Event”), I may be exposed to certain risks associated with strenuous physical activity and that I should not enter and run unless I am medically able and properly trained.  I acknowledge that I have been advised to consult with a physician regarding my health and physical condition before participating in this Event.  I assume all risks associated with running in this Event, including but not limited to, falls, contact with other participants, the effects of weather, traffic and the condition of the road/path, all such risks being known, understood and accepted by me.

In consideration of the above and my participation in the Event, I release and discharge the organizers of the Piney Orchard Elementary 5K, Piney Orchard Elementary School, Piney Orchard PTA, race director, all sponsors and the Piney Orchard Community Association, Inc., including but not limited to its directors, officers, employees, agents and residents, their successors and assigns from any and all claims, demands and liability whatsoever, including, without limitation, any claims, demands and liability for any personal injury or death, resulting from or otherwise in connection with my participation in the Event.  I agree not to file any suit, claim, complaint or charge with any court or governmental agency concerning or relating to any claim released hereunder. I have read and fully understand the Event details, and this Waiver and Release. 

I represent that I am over the age of 18 years.  If I am under the age of 18 years or if I am under a legal disability, then my parent or legal guardian has signed this Release and Waiver in the space provided below