2024 Walk Registration

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Participant Registration & Waiver Form for Epilepsy Awareness Walk in Lafreniere Park

Please complete this form and sign the waiver.
Participant Contact Information
*Required Information

    Waiver & Release of Liability for Epilepsy Awareness Walk

    I realize that walking in or volunteering for a walk potentially is a hazardous activity that can cause injury or death, and acknowledge that there are such risks inherent in my presence at or participation in the Epilepsy Awareness Walk in Lafreniere Park on Saturday, November 2, 2024. I acknowledge that this Waiver and Release of Liability will be used by the event organizers & sponsors, and that it will govern my actions and responsibilities at and during the event

    In consideration of my presence at or registration and participation in the Epilepsy Awareness Walk, I hereby agree as follows:

    1. I waive, release and discharge Epilepsy Awareness of America, Inc., its directors, officers, employees, volunteers, representatives and agents, and the Epilepsy Awareness Walk sponsors, directors and volunteers from any and all claims or liability for property damage or theft, injury, disability or death, or actions of any kid resulting from my participation in, presence at, or travel to and from the Epilepsy Awareness Walk;

    2. I agree to indemnify and hold harmless Epilepsy Awareness of America, Inc., its directors, officers, employees, volunteers, representatives and agents, and the Epilepsy Awareness Walk sponsors, directors and volunteers from any and all claims or liability for which is hereby released and waived or which may be made by any individual or entity resulting from my participation in, presence at, travel to or from, or other actions at or during the walk;

    3. I certify that I am in good health, am properly trained for this event, am physically and medically able to perform this event, and am solely responsible for same, and I knowingly and voluntarily assume all risk with respect there to. I acknowledge that the Epilepsy Awareness Walk and the event sponsors do not provide health or accident insurance for this event, and that I am solely responsible for any medical bills resulting for injuries sustained at or during the walk;

    4. I hereby consent to any medical treatment for injury or illness suffered at or during the walk; and

    5. I understand that I may be photographed at the walk and related activities, and agree that my photo, video or film likeness may be used by Epilepsy Awareness of America, Inc., sponsors to publicize or promote the event or any other legitimate purpose.

    Parent/Guardian Waiver for Minors (Under 18 years Old)

    The undersigned does hereby represent and agree, on my behalf of the participant, as follows:

    1. That I am the parent or legal guardian of the Participant;

    2. That I grant my permission and consent for the Participant to participate in the Epilepsy Awareness Walk;

    3. That I waive, release and discharge Epilepsy Awareness of America, Inc. and sponsors as provided above; and;

    4. That I agree to indemnify and hold harmless Epilepsy Awareness of America, Inc. and the walk, sponsors as provided above.

    $25.00 registration fee covers the cost of your T-shirt, refreshments and entertainment. Registration must be completed (paid) by October 24th, 2024 (to guarantee a t-shirt). Free t-shirts while supplies last. Registration may also be submitted at the event.

    Please select T-shirt size

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    We Need Your Support Today!

    Giving to the Epilepsy Awareness of America means you make the world a safer place for the over 3.4 million people in the U.S. who are living with epilepsy and seizures.