Participant Information:

• Full Name: [Your Name]

• Address: San Francisco, CA 94102

• Phone Number: 222 555 7777

• Email Address: [Your Email]

• Date of Birth: April 24, 2050

Event Details:

• Event Name: Fall Charity Run 2065

• Event Date: October 15, 2065

• Event Location: San Francisco, CA 94102

Acknowledgment of Risk:

I, [Your Name], acknowledge that participation in the Fall Charity Run 2065 involves certain risks, including but not limited to, physical injury, property damage, or even death. I understand that these risks may be inherent to the nature of the event and accept full responsibility for any injury or damage that may occur.

Release of Liability:

In consideration for being allowed to participate in the Fall Charity Run 2065, I agree to release, discharge, and hold harmless GoWorld, its sponsors, and their respective officers, directors, employees, agents, and volunteers from all liability for any claims, demands, or causes of action arising out of or related to any injury, loss, or damage sustained during the event, whether caused by the negligence of the released parties or otherwise.

I understand that this waiver and release of liability is intended to be as broad and inclusive as permitted by the laws of California and that if any portion is held invalid, the remainder will continue in full force and effect.

Signature and Date:

IN WITNESS THEREOF, the participant has executed this release on the date first written above.

If the participant is under 18 years of age, a parent or guardian must also sign:

Johann Harvey

Parent/Guardian

October 10, 2065

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