INDIVIDUAL PARTICIPANT REGISTRATION FORM
– EACH TEAM MEMBER MUST COMPLETE –
COMPETITOR INFORMATION
FIRST NAME
LAST NAME
TEAM NAME
COMPANY NAME (IF APPLICABLE)
EMAIL
– RETURN ALL SEVEN PAGES OF THIS FORM BY SEPTEMBER 1, 2017 –
Email to [email protected] with the subject line “Participant Registration Form”
or return by post to
SCI Mountain Challenge • The Seamen’s Church Institute • 50 Broadway, Floor 26 • New York, NY 10004
THE SEAMEN’S CHURCH INSTITUTE • SCI MOUNTAIN CHALLENGE
PARTICIPANT REGISTRATION FORM • PAGE 2
SEX (M/F)AGE ON DAY OF EVENT
DIETARY RESTRICTIONS
SHIRT SIZE (MEN’S - XS, S, M, L, XL, XXL)
BUSINESS CONTACT INFORMATION
ADDRESS
CITYSTATE/PROVINCE
POSTAL CODECOUNTRY
HOME CONTACT INFORMATION
ADDRESS
CITYSTATE/PROVINCE
POSTAL CODECOUNTRY
PHONE CONTACT INFORMATION
CELL PHONEBUSINESS PHONE
[email protected]
SCIMOUNTAINCHALLENGE.ORG
50 BROADWAY, FLOOR 26 • NEW YORK, NY 10004
THE SEAMEN’S CHURCH INSTITUTE • SCI MOUNTAIN CHALLENGE
PARTICIPANT REGISTRATION FORM • PAGE 3
MEDICAL RELEASE
ALL MEDICATIONS YOU TAKE CURRENTLY
ALLERGIES
MEDICAL ISSUES
QUESTIONS OR COMMENTS FOR THE RACE MEDICAL TEAM
To my knowledge the information provided above is complete and correct.
SIGNATURE
INITIALSPRINT NAMEDATE
EMERGENCY CONTACT INFORMATION
NAME
RELATIONSHIP
CONTACT NUMBER
EMAIL
[email protected]
SCIMOUNTAINCHALLENGE.ORG
50 BROADWAY, FLOOR 26 • NEW YORK, NY 10004
THE SEAMEN’S CHURCH INSTITUTE • SCI MOUNTAIN CHALLENGE
PARTICIPANT REGISTRATION FORM • PAGE 4
MEDIA WAIVER & RELEASE
I grant permission to the Seamen’s Church Institute (SCI), All Sports Events, LLC, and its subordinates, to use my name and/or photographs for
use in publications such as recruiting brochures, display boards, newsletters, and magazines, and to use my name and/or photographs for use in
electronic versions of the same publications or on website(s) or other electronic forms or media. I hereby waive my right to inspect or approve the
finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known
to me or unknown, and I waive my right to royalties or other compensation arising from or related to the use of the photograph. I hereby release,
defend, and hold harmless SCI, All Sports Events, LLC and subordinates, including any firm publishing and/or distributing the finished product in
whole or in part, whether on paper or via electronic media, from and against any claims, damages or liability arising from or related to the use of the
photographs. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that
I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure
to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
SIGNATURE
INITIALSPRINT NAMEDATE
[email protected]
SCIMOUNTAINCHALLENGE.ORG
50 BROADWAY, FLOOR 26 • NEW YORK, NY 10004
THE SEAMEN’S CHURCH INSTITUTE • SCI MOUNTAIN CHALLENGE
PARTICIPANT REGISTRATION FORM • PAGE 5
SUNDAY RIVER SKIWAY CORPORATION
ACKNOWLEDGEMENT, ASSUMPTION OF RISKS AND RELEASE OF LIABILITY
ACKNOWLEDGMENT AND ASSUMPTION OF RISK
I understand that participation in the 2017 SCI Mountain Challenge (the “Activity”) may be hazardous and involve known and unknown risks, which
include, but are not limited to, changing weather and surface conditions, falls resulting from man-made and natural objects, design and condition
of natural and man-made elements, severe terrain changes and collisions with other participants, spectators, vehicles, and natural and man-made
objects. I AGREE FREELY AND VOLUNTARILY TO ASSUME ALL RISKS, including the risk of physical injury, death and/or damage to person or
property associated with participation in the Activity.
RELEASE, INDEMNITY AND HOLD HARMLESS AGREEMENT
I agree for myself, my heirs and for anyone on my behalf, to the fullest extent allowed by law, to RELEASE, INDEMNIFY AND HOLD HARMLESS
Sunday River Skiway Corp. and Boyne USA, Inc. (hereinafter collectively referred to as “Sunday River”), including their owners, directors, officers, real
and personal property owners, shareholders, employees, volunteers, agents, representatives, affiliates, successors and assigns (hereinafter collectively
referred to as “Releasees” ) from any and all responsibility or legal liability for any property damage, personal injury, damage or death which may
result directly or indirectly from participation in the Activity, whether or not such injury or damage was foreseeable, or any other cause or claim
arising from participation in the Activity under any legal theory, including ANY CLAIMS BASED ON ALLEGED NEGLIGENCE OF RELEASEES.
PROMISE NOT TO SUE
I PROMISE TO NOT SUE, and to INDEMNIFY, HOLD HARMLESS AND DEFEND Releasees for any claim of injury, damage or death which
may result from my participating in the Activity, including any claims based on alleged NEGLIGENCE of Releasees. Should any claim or action be
asserted in contravention to this agreement, I or my successor shall be liable for all expenses, INCLUDING LEGAL FEES incurred by Releasees,
and that if a claim or action is brought, it shall be submitted to the jurisdiction of the State or Federal Court in the State of Maine, and no other
jurisdiction, and shall be governed by the laws of the State of Maine.
PHOTOGRAPHY & VIDEO RELEASE
In consideration of my participation in the Activity, I hereby authorize and give full consent to Releasees to copyright or publish all photographs and
video in which I appear while enrolled as a participant in the Activity. I further agree that this/these photograph(s) and/or video(s) maybe used for
any and all exhibitions, public displays, publications, commercials, art and advertising purposes, without limitation or reservations.
I have carefully read and understand this agreement is a COMPREHENSIVE RELEASE OF ALL LIABILITY which is binding upon me, my heirs, agents
and assigns, that is not intended to assert any claims or defenses that are prohibited by law, and that if any part of this agreement is held to be
invalid or unenforceable, the remainder shall be given the full force and effect.
SIGNATURE
INITIALSPRINT NAMEDATE
ADDRESS
[email protected]
SCIMOUNTAINCHALLENGE.ORG
50 BROADWAY, FLOOR 26 • NEW YORK, NY 10004
THE SEAMEN’S CHURCH INSTITUTE • SCI MOUNTAIN CHALLENGE
PARTICIPANT REGISTRATION FORM • PAGE 6
ALL SPORTS EVENTS
WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT
PLEASE READ THIS ACKNOWLEDGEMENT, WAIVER AND RELEASE FROM LIABILITY (AWRL) BEFORE REGISTERING
I acknowledge that an adventure race is an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious
injury, and property loss. I HEREBY ASSUME THE RISKS OF PARTICIPATING IN THIS EVENT. I certify that I am physically fit, have sufficiently
trained for participation in this event(s), and have not been advised against participation by a qualified health professional. I acknowledge that
my statements on this AWRL are being accepted by ALL SPORTS EVENTS, LLC, the various race sponsors, organizers and administrators in
consideration for permitting me to participate in this event.
In consideration for allowing me to participate in this event, I hereby take the following action for myself, my executors, administrators, heirs
next of kin, successors and assigns, or anyone else who might claim or sue on my behalf, and I expressly acknowledge that it is my intent to take
these actions: (a) I AGREE to abide by the Competitive Rules and Regulations adopted by this event (b) I AGREE that prior to participating
in this event I will review all race course information provided and attend the mandatory participant meeting. If I believe that any part of the
course, facilities, equipment, and areas to be used are unsafe I will immediately advise the person supervising the event; (c) I AGREE to cover the
replacement costs of any timing chips/ankle straps, communication and tracking devices or any other equipment provided to me that I lose; (d) I
WAIVE, RELEASE, AND FOREVER DISCHARGE from any and all claims, losses (economic and non-economic), or liabilities, for death, personal
injury, partial or permanent disability, property damage, medical or hospital bills, theft, or damages of any kind, which may in the future arise
out of, result from, or relate to my participation in or my traveling to or this event, THE FOLLOWING PERSONS OR ENTITIES: ALL SPORTS
EVENTS LLC, EVENT SPONSORS, RACE DIRECTORS, EVENT PRODUCERS, VOLUNTEERS, ALL STATES, CITIES, COUNTRIES, OR OTHER
GOVERNMENTAL BODIES OR LOCATIONS IN WHICH EVENTS OR SEGMENTS OF EVENTS ARE HELD, AND THE OFFICERS, DIRECTORS,
EMPLOYEES, REPRESENTATIVES AND AGENTS OF ANY OF THE ABOVE, EVEN IF SUCH CLAIMS, LOSSES, OR LIABILITIES ARE CAUSED
BY THE NEGLIENT ACTS OR OMISSIONS OF THE PERSONS I AM HEREBY RELEASING OR ARE CAUSED BY THE NEGLIGENT ACTS OR
OMISSIONS OF ANY OTHER PERSON OR ENTITY; (e) I ACKNOWLEDGE that there may be traffic or persons on the course route, and I
ASSUME THE RISK OF RUNNING, HIKING, PADDLING, SWIMMING OR PARTICIPATING IN THIS EVENT under these circumstances. I also
ASSUME ANY AND ALL OTHER RISKS associated with participating in this event including but not limited to falls, contact and/or effects with
other participants, effects of weather including heat, cold, and/or humidity, defective equipment, the condition of the roads, water hazards, contact
with other swimmers or boats, and any hazard that may be posed by spectators or volunteers, all such risks being known and appreciated by
me; and I further acknowledge that these risks include risks that may be the result of the negligence of persons or entities mentioned above in
subparagraph (d) or of other persons or entities. I FURTHER COVENANT AND AGREE NOT TO SUE any of the persons or entities mentioned
above in subparagraph (d) for any of the claims, losses, or liabilities that I have waived, released, or discharged herein; and I INDEMNIFY AND
HOLD HARMLESS the persons or entities mentioned above in subparagraph (d) from any and all expenses incurred, claims made, or liabilities
assessed against them, including but not limited to attorneys’ fees and litigation expenses, arising out of or resulting from, directly or indirectly, in
whole or in part, (i) my actions or inactions, (ii) my breach or failure to abide by any part of this AWRL including but not limited to my covenant
not to sue; (iii) my breach or failure to abide by any of the Competitive Rules; or (iv) any other harm caused by me.
I HEREBY AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER, I HAVE READ THIS DOCUMENT, AND I UNDERSTAND ITS
CONTENT.
MY INSURANCE COMPANY
I HAVE SIGNED THIS WAIVER AND AGREEMENT ON THE DAY OF 2017
SIGNATURE
INITIALSPRINT NAME
[email protected]
SCIMOUNTAINCHALLENGE.ORG
50 BROADWAY, FLOOR 26 • NEW YORK, NY 10004
THE SEAMEN’S CHURCH INSTITUTE • SCI MOUNTAIN CHALLENGE
PARTICIPANT REGISTRATION FORM • PAGE 7
THE SEAMEN’S CHURCH INSTITUTE
WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT
1. In consideration for volunteering to participate in the SCI Mountain Challenge on September 28-October 1, 2017, I hereby RELEASE, WAIVE,
DISCHARGE, AND COVENANT NOT TO SUE the Seamen’s Church Institute (SCI), their officers, agents, or employees (hereinafter referred to
as RELEASEES) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or
injury, including death, that may be sustained by me, or to any property belonging to me, while participating in such activity, while in, on or upon
the premises where the activities are being conducted, REGARDLESS OF WHETHER SUCH LOSS IS CAUSED BY THE NEGLIGENCE OF THE
RELEASEES, or otherwise and regardless of whether such liability arises in tort, contract, strict liability, or otherwise, to the fullest extent allowed by
law.
2. I am fully aware of the risks and hazards connected with the activities of participating in an adventure race and I am aware that such activities
include the risk of injury and even death, and I hereby elect to voluntarily participate in said activities, knowing that the activities may be hazardous
to my property and my person. I understand that SCI does not require me to participate in this activity. I voluntarily assume full responsibility for
any risks of loss, property damage, or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by
me, as a result of being engaged in such activities, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise, to the fullest extent
allowed by law.
3. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage, or costs, including court costs
and attorneys’ fees that Releases may incur due to my participation in said activities, WHETHER CAUSED BY NEGLIGENCE OF RELEASEES or
otherwise, to the fullest extent allowed by law.
4. It is my express intent that this Waiver and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my
heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT
TO SUE the above-named RELEASEES. Any portion of this document deemed unlawful or unenforceable is severable and shall be stricken without
any effect on the enforceability of the remaining provisions.
IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Wavier of Liability and Hold Harmless
Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the
foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Agreement for full,
adequate and complete consideration fully intending to be bound by same.
I HAVE SIGNED THIS WAIVER AND AGREEMENT ON THE DAY OF
2017
SIGNATURE
INITIALSPRINT NAME
[email protected]
SCIMOUNTAINCHALLENGE.ORG
50 BROADWAY, FLOOR 26 • NEW YORK, NY 10004