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CRAWL FOR A CAUSE BAR CRAWL BENEFITING
Appendix Cancer Pseudomyxoma Peritonei Research Foundation (ACPMP)
October 5, 2019
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
WARNING: BY SIGNING THIS DOCUMENT, YOU GIVE UP IMPORTANT LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. PLEASE READ CAREFULLY BEFORE YOU SIGN!
ALL PARTICIPANTS MUST BE 21 OR OLDER
NAME OF PARTICIPANT: ___________________________________________ PHONE NO: __________________
BIRTH DATE OF PARTICIPANT: _______________________ AGE OF PARTICIPANT: _________________
EMAIL ADDRESS OF PARTICIPANT: ________________________________________________________________
NAME OF EMERGENCY CONTACT: _________________________________ PHONE NO: __________________
RELATIONSHIP TO PARTICIPANT: __________________________________
Intending to be legally bound, I hereby certify that:
1. I am 21 years of age or older.
2. I am submitting this release of liability, waiver of claims, assumption of risks and indemnity agreement
voluntarily and of my own free will.
3. I have no physical or emotional problems, or any history thereof, which will impair my ability to participate in
this event in a safe manner.
The organizers, For A Cause, LLC, App, Appendix Cancer Pseudomyxoma Peritonei Research Foundation (“ACPMP”),
establishments, sponsors, and volunteers (and the administrators, directors, agents, officers, and employees of each) of this
event are not responsible for any injury, loss or damage of any kind sustained by any person while participating in the
Crawl for a Cause, including injury, loss or damage which might be caused by the action, inaction, or negligence of
others. I hereby for myself, my heirs, executors, administrators or anyone else who might claim in my behalf, covenant
not to sue, and waive, release and discharge the event organizers, ACPMP, the establishments, sponsors, and volunteers
(and the administrators, directors, agents, officers, and employees of each) of any and all claims of liability for death,
personal injury or property damage of any kind or nature whatsoever arising out of, or in the course of my participation in
this event. This covenant, waiver, release and discharge extends to all claims of every kind or nature whatsoever, foreseen
or unforeseen, known or unknown.
ASSUMPTION OF RISKS
As a requirement of and in consideration of my voluntary participation in Crawl for a Cause, I acknowledge that I am
aware of the possible risks, dangers and hazards associated with my participation in the Crawl for a Cause (including the
risk of severe or fatal injury to myself or others). These risks include but are not limited to the following:
a) the risks associated with travel to and from location(s) to be visited during the Crawl for a Cause, including
transportation provided by commercial, private and/or public motor vehicles;
b) intoxication and/or alcohol poisoning from the alcohol I consume whether voluntarily or through coercion;
c) the possibility of bodily injury of any kind, including dental damages, from (1) falling down, (2) entering or
exiting the mode of transportation being used for the event, and (3) being knocked down or being involved in a
physical confrontation whether caused by myself or someone else;
d) the risks associated with returning to my residence after participating in the event, whether travelling by foot or in
any kind of commercial, private and/or public mode of transportation.
INDEMNIFICATION AND RELEASE OF LIABILITY
As a requirement of and in consideration of my voluntary participation in Crawl for a Cause and related activities, I agree:
1. TO ASSUME AND ACCEPT ALL RISKS arising out of, associated with or related to my participating in Crawl
for a Cause, even though such risks may have been caused by the action(s), inaction, or negligence of others;
2. TO BE SOLELY RESPONSIBLE FOR ANY INJURY, SOCIAL AND ECONOMIC LOSS, COST OR
DAMAGE which I might sustain while participating in the Crawl for a Cause even though such injury, loss or
damage may have been caused by the action(s), inaction, or negligence of others;
3. TO HOLD HARMLESS AND INDEMNIFY THE EVENT ORGANIZERS, For A Cause, LLC, ACPMP,
establishments, sponsors, and volunteers, and administrators, directors, agents, officers, and employees of each:
a) from any and all liability for any damage to the personal property of, or personal injury to, any third party
resulting from my participation in Crawl for a Cause and all related activities; and
b) from any and all claims, demands, actions, losses and costs which might arise out of my participating in
Crawl for a Cause, even though such claims, demands, actions, losses and costs may have been caused by
the action(s), inaction, or negligence of others.
By signing below, I consent to having the information in this document collected by event organizers. Certain personal
information may be made available to federal and provincial government departments and agencies under appropriate
legislative authority. Personal information is protected and will be treated as confidential.
I acknowledge that I have read this document, that I have executed this document voluntarily and without any inducement
or assurance of any nature, that I intend it be a complete and unconditional release of all liability to the greatest extent
allowed by law, that I understand that I have given up substantial rights by signing it, and that my agreement is to be
binding upon myself, my heirs, executors, administrators and representatives, in the event of my death or incapacity.
Printed Name of Participant
Signature of Participant (must be 21 or over) Date