2017 Los Angeles CORPORATE CHALLENGE
WAIVER & INDEMNITY / ELIGIBILITY VERIFICATION FORM
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Every participant must personally read, understand, and execute this waiver form.
READ BEFORE SIGNING
LIABILITY WAIVER AND RELEASE/ASSUMPTION OF RISK. I fully comprehend the risk of personal injury and property damage that may arise from my participation in any Los Angeles Corporate Challenge game and/or event (Corporate Challenge), and hereby agree to assume such risk. I further waive any and all claims of any kind that I, or my respective heirs, executors, administrators, or assigns may have or claim to have for personal injury, illness, and property damage, of any kind or character whatsoever, resulting from my participation in any and all Corporate Challenge games, activities, meetings and events, against Los Angeles Corporate Challenge, Inc. (LACC), my employer, all sponsors, City of Los Angels, all other event location owners and organizations, all participating companies and organizations, including their employ- ees, agents and representatives, and all LACC Board Members, Ambassadors, Games Captains, and Volunteers (Released Parties), and hereby release the foregoing from liability for any such claims which may arise from, or occur as a result of my participating in Corporate Challenge. Although the body of water used in the Corporate Challenge Triathlon is tested and compliant with the Los Angels Department of Health and Environment requirements for water quality; I realize that natural occurrences may change water quality at any given time and I assume this risk. I understand that there is risk and danger incidental to entering a natural body of water.
INDEMNITY. In further consideration of the opportunity to participate in Corporate Challenge, I hereby agree to indemnify and hold harmless the Released Parties from and against any and all claims of third parties, including but not limited to fellow employees and members of the public, for personal injury, illness, and/or property damage which may result from or be caused by my own intentional, deliberate or negligent conduct. This indemnity shall survive regardless of when such claims are asserted.
CERTIFICATION OF GOOD HEALTH. I certify that I am in good physical health, have the permis- sion and clearance of a licensed physician to participate in Corporate Challenge events, and have no physical condition, impairment, disease, infirmity, other illness, or history of chronic respirato- ry or circulatory ailments, including heart disease or blockage, that would prevent or jeopardize my safe participation in Corporate Challenge or place me at risk of further injury, illness or death during my participation.
PERMISSION TO -- USE NAME AND PHOTO. I hereby grant my permission to the LACC for the free use of my name and photograph in any print media, social media, broadcast, telecast, or video account of any Corporate Challenge game and/or event.
By signing this form, I acknowledge that I have read the form in its entirety, fully understand and agree with its contents, and fully accept all terms, conditions, and provisions and I have not altered the form in any way. I further acknowledge by my signature that I have read the eligibility rules as stated on the reverse side of this form, and I meet those requirements for participation.