Carbon County Recreation
             
 
Push to Survive Individual Registration:   $15.00   Quantity:   Item Subtotal:  
$0.00
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Push to Survive Family Registration:   $25.00   Select:   Item Subtotal:  
$0.00
(Family price does not include t-shirts)
Number of Family Members Participating:     Quantity:    
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Push to Survive T-Shirts:   $8.00   Quantity:   Item Subtotal:  
$0.00
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Total:
$0.00
Payer's Information
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Running Race Registration and Liability Release Agreement

This is not a closed course, there will be vehicles on the roadway. Stay on the side of the road you are told to run on. Move to the edge of the road when vehicles approach. Please read this agreement completely and understand the risked involved. The course if marked on the roadway with arrows.

This agreement specifically sate you understand the risks involved and you are willing to assume those risks. You will hold no one responsible for your safety or well-being. No accident insurance is provided. It is the responsibly of the participant to secure appropriate insurance.

By signing this agreement, you understand and agree to the following things:

  1. Carbon County Recreation assumes no responsibility for you safety or well-being.
  2. Running dangers include but are not limited to, limited sight distance, uneven roadway, rocks in the roadway, exhaustion, and errors in judgment. Injury or even death may occur, even though all precautions are taken.
  3. Each participant much take person responsibility for his/her actions and the consequences of those actions.

ACKNOWLEDGMENT OF RISK
    I understand running on roads (sometimes gravel) open to vehicles is potentially dangerous. Even though all precautions are taken, potential dangers include, but are not limited to, unleveled terrain, weather conditions, slick surfaces, uneven surfaces, stepping on a rock, failure to follow safety guidelines, participant fatigue, dehydration, sunburn, heat exhaustion, and human error in judgment. Runners may fall down, collide with another runner or vehicle, or become exhausted and disoriented. With this understanding, I agree to all terms and conditions listed herein. I realize that signing this document is not a mere formality, but a legal document and recognize its validity in a court of law.
    In addition, I certify that I am in good physical condition and that I have no medical problems which will prohibit my safe participation in this event. I understand running is physically demanding and accept full responsibility for myself, my actions, and my well-being. I agree to hold no one responsible for anything that may happen to me while participating in this event, regardless of who may be at fault. I have these medical conditions that may affect my ability to participate safely in this activity (all medical conditions must be disclosed)

Medical Information

CONTRACT, WAIVER, RELEASE AND INDEMNIFICATION

    I agree to indemnify and hold harmless Carbon County, employees, as well as volunteers with this running race from all claims, damages, losses, injuries and expenses arising out of or resulting from participation in this event.
    I authorize and release Carbon County the use of my image in any photograph or video recording for any purpose of Carbon County.
    I hereby give permission for transportation to any medical facility or hospital and I authorize any qualified employee, volunteer, or medical personnel to render necessary emergency medical care.  I hereby authorize the release of any medical information, in the possession of Carbon County to any medical facility, hospital, ambulance, first aid provider, first aid service, doctor, nurse or other such person rendering care on my behalf.  I hereby waive any action or claim against Carbon County or any health care provider, hospital, doctor, nurse or first aid provider for the release of this medical information.
    I certify that I am in good physical condition and that I have no medical problems that will prohibit my safe participation in this event. I accept full responsibility for my well-being and hold no one responsible for anything that may happen to me while participating in this event, regardless of who may be at fault

Participant(s)
I have read and agree to the statements above.
 
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Carbon UT 800-764-0844 Price UT

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