Entry Form / Release Form
Meadows Monster – YETI Trail Series
12/04/21
01/01/22
02/05/22
03/05/22
10:00 AM: Lowell Park – Dixon, Illinois
Date: ____________________
Name: _______________________________________________ Age: _____________ Gender: Male / Female
Address: _____________________________________________City: ________________ Zip: ____________
E-mail: ______________________________________________________________ (FOR RACE RESULTS)
Emergency Contact: __________________________________________ Phone: _______________________
Waiver and Release of Liability Agreement
I, the undersigned, hereby acknowledge and understand that the athletic event commonly known as the Meadows Monster YETI Trail Series held on Saturday, Dec. 04, 2021; Jan. 1, 2022; Feb. 5, 2022 and Mar. 5, 2022, at Lowell Park located in Lee County, Illinois (the “Event”), is an extreme test of individual physical and mental limits and carries with it certain risks including, but not limited to, death, serious injury and property loss, caused by such things as nutrition, hydration, terrain, facilities, weather conditions, equipment, vehicular traffic, actions of other people such as participants, volunteers, spectators, coaches, officials, and/or organizers of this Event. I acknowledge that these risks are inherent in athletic events of this type. I hereby assume all of the risks of participating and/or volunteering in this Event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released hereby and/or from dangerous or defective equipment or property owned, maintained or controlled by them. I certify that I am physically fit and prepared to participate in this Event and have not been advised otherwise by qualified medical personnel. I acknowledge that this Accident Waiver and Release of Liability form will be used by the event holders, sponsors and organizers of the Event and that it will govern my actions and responsibilities at the Event. In consideration of my application and allowing me to participate in the event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:
I expressly and voluntarily Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, and/or property theft, the following entities or persons: the Dixon Park District, City of Dixon, County of Lee, Raynor and its directors, officers and employees, the Event organizers, directors, sponsors, volunteers, and any and all officers, employees, volunteers and agents of the foregoing entities/organizations (collectively, the “Released Parties”). Further, I expressly and voluntarily Indemnify and Hold Harmless the Released Parties from any and all liabilities or claims made as a result of participation in the event, whether resulting from one’s negligence or otherwise.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during the Event. I understand that during the Event or related activities, I may be videotaped and/or photographed. I agree to allow my photo, video, film and/or other electronic likeness to be used for any legitimate purpose by the Event holders, producers, sponsors, organizers and their assigns.
This Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I hereby certify that I have read this document, and I understand its content.
Signature:___________________________________________________________________________________
Date: ______________________
Signature of Guardian (if participant is under 18): ___________________________________________________
Date: ______________________
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