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Mighty Milers Fun Run/Walk Race Release Form

Parent/Guardian: Entry to the NYRR event listed below is free for Mighty Milers participants. Please fill out this form to give the
below-named Mighty Milers participant permission to run. Please note that you may need to meet with your Site Coordinator (School
Staff) earlier than the times listed below.
First and Last Name of Runner:

Street Address:

Apartment #:

City:

State:

Phone:

E-mail if available:

School/Team Name:

Grade:

Zip Code:

Check one:

Date

Thurs., May 21

Male

Female

Event

Distance

Time

Location

Mighty Milers Fun Run/Walk


Pre-K to 2nd grade

1/4 Mile

Arrive at 9:3

Icahn Stadium, Randalls Island

Note: In case of inclement weather, this event will be moved to the Harlem Armory (40 W. 143rd St.) in Manhattan
and become a Fitness Festival. *Subject to change.
The undersigned Participant and his/her parent or guardian (collectively, Releasors), in consideration of Participant being provided by New York Road Runners, Inc. (NYRR)
the opportunity to participate in the "Mighty Milers" Events, as defined below, each hereby voluntarily represents and agrees as follows:
1. That there are inherent risks and the potential for injury that may result from participating in any NYRR events and activities in connection therewith, including but not limited
to practices, trainings, races, jamborees, related gatherings and transportation thereto (collectively, the Events), including but not limited to falls; contact with other participants,
spectators or others, or vehicular or other traffic; the effects of the weather, including heat and/or humidity, wind, cold temperature, and wet or icy surfaces; falling tree branches
or other overhead objects; traffic; and the crowded nature and other conditions of the Event course or facility; and each Releasor hereby assumes all such risks and responsibility
for any and all injury, damage or loss that may result from participation in the Events.
2. I represent that Participant will not participate in any Events unless Participant is medically able and agree that it is Releasors responsibility to consult with a physician prior to
him/her participating in the Events to determine if he/she is medically able to participate in the Events. Releasors grant to Releasees or their designees permission to administer
or arrange for any medical assistance that they deem necessary or appropriate as a result of participation in the Events, including without limitation, arranging transportation to
a hospital or other medical facility. Releasors also grant them access to Participants medical records and physicians, as well as other information, relating to medical care that
may be administered to Participant at any such medical facility as a result of participation in the Events.
3. Releasors further acknowledge that Releasees reserve the right to change the details (such as the date, start time, course, and distance) of, and amenities, if any, offered at the
Events at any time and for any reason, and Releasors hereby and waive and release any claims that Releasors may have as a result of any such change.
4. I, on behalf of myself, my representatives, heirs, successors and assigns, do hereby release New York Road Runners, Inc.; U.S.A. Track & Field and its constituent associations;
the City of New York, its agencies, departments and officials; and all sponsors and officials of the Events; and the employees, volunteers, including medical volunteers, and other
representatives, agents, and successors of each of the foregoing (the Releasees), from present and future claims and liabilities of any kind, known or unknown, arising out of
Participants participation in the Events, even though such claim or liability may arise out of negligence or fault on the part of any of the Releasees.
5. Releasors hereby agree that any current or future controversy or claim between Releasors and any of the Releasees (including their former, current, or future related affiliated
entities) and/or between Releasees and any of the Releasees former, current, or future partners or employees (in their institutional or personal capacities) (each a Covered Person)
arising out of or relating to participation with the Releasees must be submitted to confidential, final and binding resolution by a private and impartial arbitrator to be jointly selected
by Releasors and the Releasees from a list of neutral arbitrators provided by JAMS, The Resolution Experts (JAMS), and that the arbitration will be conducted in accordance with
the then-current JAMS Employment Arbitration Rules & Procedures (the Rules). Releasors further agree that the arbitrator shall have the power to award any remedies, including
attorneys fees and costs, available under applicable law. Releasors acknowledge that judgment upon the award rendered by the arbitrator may be entered in any court having
jurisdiction, and that the award may be vacated or modified only on the grounds specified in the Federal Arbitration Act or other applicable law. Releasors understand that
any arbitration conducted pursuant to this agreement shall take place in New York, New York, unless an alternative location is chosen by mutual written agreement of the Parties.
In agreeing to submit all disputes for resolution by arbitration, Releasors acknowledge that such agreement is given in exchange for rights or benefits to which Releasors are not
otherwise entitled and the more expeditious and confidential resolution of any such disputes.
6. Releasors hereby agree that all claims must be pursued on an individual basis only. By signing this agreement, Releasors hereby waive the right to commence, or be a party to,
any class or collective claims or to bring jointly any claim against the Releasees with any other person.
7. I grant permission to the Releasees to use or authorize others to use any photographs, motion pictures, video or sound recordings, or any other record of Participants participation
in the Events, including Participants name and likeness, for any purpose without remuneration.
8. I grant permission for Participant to be transported to or from the Events by motor vehicle operated by a licensed operator pursuant to arrangements made by any of the releasees.

Name of Parent/Guardian (Please Print)

Signature of Parent/Guardian
(please print out and sign this form manuallyonly hand-written signatures will be accepted)

2014-2015

Todays Date