The Big Bed Push Fundraiser

Name *

First Name

Last Name

Phone # *

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Emergency Contact *

First Name

Last Name

Emergency Contact Phone # *

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Waiver *

Please read the following and fill out this waiver to participate in the bed push (event). If you are under the age of 18, a parent or legal guardian must sign the form to acknowledge their consent. BED PUSH WAIVER AND RELEASE OF LIABILITY READ BEFORE SIGNING In consideration of being allowed to participate in any way in “THE BIG PUSH”/MICHAEL STRINGER/CROSSFIT QUISPAMSIS/BED PUSH FUNDRAISER, related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) from the activities involved in this program are significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS “THE BIG PUSH”/MICHAEL STRINGER/CROSSFIT QUISPAMSIS their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. CHOOSING 'I CONSENT' BELOW CONSTITUTES "SIGNING" THIS WAIVER AND RELEASE OF LIABILITY.

I am over 18 and I consent

I am the parent/guardian of a participant and I consent on their behalf

I do not consent