ARTICIPANT WAIVER, RELEASE OF Name (Print):__________________________
COVENANT NOT TO SUE & IMAGE RELEASE
Event Location: 1 County Road 101
Moulton, AL 35650
In consideration of being allowed to participate in any way in the above referenced D.M.R.LLC competition(s), race(s), related
events (the “Event”) and/or activities, I, the undersigned, acknowledge, covenant and agree that:
- D.M.R.LLC and the Event is significant including, but not limited to the following: (i) drowning;
(ii) near-drowning; (iii) sprains; (iv) strains; (v) fractures; (vi) heat and cold injuries; (vii) over-use syndrome; (viii) injuries involving vehicles; (ix) animal bites and/or
stings; (x) contact with poisonous plants; (xi) accidents involving, but not limited to paddling, climbing, biking, hiking, skiing, snow shoeing, travel by boat, truck, car,
or other convenience;(xii) heart attack and (xiii) the potential for permanent paralysis and/or death. While particular rules, equipment, and personal discipline may
reduce this risk, the risk of death or serious injury does exist;
BOTH KNOWN AND UNKNOWN, and assume full responsibility and all risks for my participation in the Event;
during my presence or participation, I will remove myself from participation and bring such hazard to the attention of the nearest official;
SUE D.M.R.LLC, Diamond Hollow Farms, Billy Mitchell Jewelry, Inc., Peggy Mitchell, Mylan Mitchell, Stephen Kilpatrickand their officers, family members,
directors, representatives, officials, principals, agents and/or employees, subsidiaries, and/or assigns, as well as their independent contractors, sponsoring agencies,
sponsors, advertisers, volunteers, and if applicable, owners and lessors of the premises used to conduct the Event (collectively, the "Releasees"), WITH RESPECT TO
ANY AND ALL INJURY, DISABILITY, DEATH, and/or loss or damage to person or property, incurred by me in connection with participation in the Event. I further
agree to indemnify, defend and hold harmless Releasees from any loss, liability, cost, claim or damages arising from my participation in or association with activities
and events organized and sponsored by D.M.R.LLC. or connected with the Event.
participation in the Event and that I am physically fit and sufficiently trained to participate in all activities associated with the Event. My participation in activities and
events organized or sponsored by D.M.R.LLC is entirely voluntary. I further certify and represent that on the date of the Event I will possess
and be covered by medical/health insurance, individually or as part of an organization.
liability or claims arising out of such treatment.
beyond the control of the Releasees that might affect the health and/or safety of the participants.
No refunds will be granted. Registration cost can be transferred to another race provided by D.M.R.LLC. Initial____________
or any other depiction of any kind of me or of my participation in the Event or related activity for any legitimate purpose in perpetuity and I understand that I shall not
be entitled to any compensation therefore.
herein as “I”, “me”, “my”) in the Event and subsequently to telecast, sell, distribute and otherwise utilize the same in whatever manner Releasees shall deem
broadcast, my name, nickname, image, likeness, voice, photograph, signature facsimile, and biographical information in connection with the Event without
compensation of any kind to me. I acknowledge that Releasees and their representatives shall have the unlimited right throughout the world to copyright, use, reuse,
publish, republish, broadcast and otherwise distribute depictions of or information about me and all or any portion of the Event in which I may appear on any and all
radio, network, cable and local television programs and in any print materials and in any other format or media (including electronic media) now known or hereinafter
devised in perpetuity and without compensation to me. In consideration and in return for being allowed to participate in the Event, I release and agree not to sue the
Releasees from all present and future claims regarding my participation in the Events that may be made by me, my family, estate heirs, or assigns.
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.
Participant Name (PRINT): __________________________________________________
Signature _______________________________________ Date ____________________
EMERGENCY CONTACT (required) Name _______________________________________
MINORS: IF UNDER 19 – SIGNATURE OF PARENT OR GUARDIAN (required)
The undersigned, _______________________________________, hereby certifies, warrants and represents that I am the legal parent or guardian of
____________________________,the signer of the above Release (the “Participant”), and that after fully informing myself regarding the nature and
risks of the Event, I give my permission for Participant to participate in the same and by my signature below I fully ratify, accept and agree to all of
the terms of the above Release both for myself individually and as legal parent or guardian of the Participant.