COLOR ONEONTA 2016

COLOR ONEONTA 2016
Registration Form
First Name:
Last Name:
Email:
Address:
Wave:
9:00AM
9:30AM
10:00AM
10:30AM
Shirt Size:
Phone:
Birthdate:
Gender:
Male
Female
I have read and signed the attached waiver:
YES
NO
Please include a check made payable to Lighthouse Christian Academy
using the ticket prices below.
Registration forms can be turned in or mailed to:
Lighthouse Christian Academy
12 Grove Street
Oneonta, NY 13820
Office hours are Mon-Fri 9-12PM
Before June 10, 2016 $25.00 for Adults $15 for children 12 and under
After June 10, 2016 $30.00 for Adults $20.00 for children 12 and under
COLOR ONEONTA 2016
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK,
AND INDEMNITY AGREEMENT (“AGREEMENT”)
In consideration of being permitted to participate in Color Oneonta Color Run conducted by Lighthouse
Christian Academy the undersigned “RELEASOR” represents that the Participant understands the nature of
the Activity and that the Participant is qualified, in good health, and in proper physical condition to participate
in such Activity. I also declare that I am not pregnant knowing that if I participate that harm could come to my
unborn child. __________ (initial here)
RELEASOR fully understands that the Activity involves risks of serious bodily injury, including
permanent disability, paralysis, and/or death, which may be caused by Participant’s own actions, or inactions,
those of others participating in the event, the conditions in which the event takes place, or the negligence of
any one or more of the “RELEASEES” named below; and that there may be other risks either not known to
RELEASOR or not readily foreseeable at this time; and RELEASOR fully accepts and assumes on behalf of
Participant all risk of bodily injury, death or property damage due to the negligence of any one or more of the
RELEASEES or otherwise as a result of the Participant’s participation in the Activity.
RELEASOR hereby releases, discharges, and covenants not to sue LIGHTHOUSE CHRISTIAN ACADMEY,
FULL GOSPEL LIGHTHOUSE INC., FIVE STAR SUBARU, FIRST NIGHT ONEONTA INC., and also THE
CITY OF ONEONTA, its respective shareholders, administrators, directors, agents, owners, officers,
volunteers and employees, other participants, all sponsors, advertisers, and owners and lessors of the
premises on which the Activity takes place (each considered one of the RELEASEES herein), from all liability,
claims, demands, losses or damages, on account of injury to the Participant’s person or property whether
caused by the negligence of any one or more of the RELEASEES or otherwise while Participant is
participating in the Activity, including negligent rescue operations; and further agrees that if, despite this
release, waiver of liability, and assumption of risk RELASOR, or anyone of Participant’s behalf, makes a
claim against any of the RELEASEES, RELEASOR will indemnify, save, and hold harmless each of the
RELEASEES from any loss, liability, damage, or cost, which any may incur as the result of such claim.
I give exclusive permission to LIGHTHOUSE CHRISTIAN ACADEMY AND FIVE STAR SUBARU, to take
pictures that will possibly be posted on any of the named companies websites, social media, and may be
used in advertisement.
RELEASOR has read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND
INDEMNITY AGREEMENT, understand that the RELEASOR and Participant have given up substantial rights
by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to
be a complete and unconditional release of all liability to the greatest extent allowed by law and agree if any
portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and
effect.
Printed Name of Participant:
Date:
Signature (Must be 18 or Older):
Printed Name of Parent /Guardian:
Signature of Parent/Guardian:
Emergency Contact
Contact Name:
Phone:
Relationship:
Alternate Phone: