2026 Walk Registration

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 7, 2026. 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.

$35.00 registration fee covers the cost of your T-shirt, goodie bag, entertainment, lunch and refreshments. Registration must be completed (paid) by October 31, 2026 (to guarantee a t-shirt). It must be completed by November 4 at midnight for the $35.00 fee. After November 4, 2026 the registration fee is $40.00 and it does not guarantee a t-shirt.