Yogathon Participant Offline Registration Form - Living Yoga

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YOGATHON   P ARTICIPANT  
OFFLINE   R EGISTRATION   F ORM  
Yogathon   C hallenge,   $ 20,   A pril   1 4th-­‐May   2 5th   2 013  
 
 
 
Name:   _ __________________________________________________________    
PAYMENT   O PTIONS:  
Email:       __________________________________________________________    
____Cash,   $ _________________  
Address:  _________________________________________________________    
____Check,   $ ________________  
City:  _____________________________     S tate:     _ ____     Z ip:       ________________    
____Credit,     $ _______________  
Phone:       __________________________________________________________    
Credit   C ard   N umber:  
Your   Y oga   C lass   C hallenge   G oal   ( e.g.   1 0,   2 0,   5 0   c lasses):  ___________________    
____________________________  
_ _
_ _
_ _
_ _
T-­‐shirt   s ize*:  
Small      
Medium    
Large    
XL     ( *t-­‐shirts   a nd   p rizes  
Exp.   d ate:   _ ________________    
are   a warded   b ased   o n   f undraising   t arget   l evels   a nd   w ill   b e   g iven   o ut   a t   t he   e nd  
of   t he   Y ogathon   e vent)  
Security   C ode:     _ ____________  
 
LIVING   Y OGA   Y OGATHON   E VENT   T ERMS   &   C ONDITIONS   O F   P ARTICIPATION
 
I   c onfirm   a nd   a gree   t o   t he   f ollowing   t erms   a nd   c onditions.  
I   a m   o ver   1 8   y ears   o f   a ge.  
I   a cknowledge   a nd   a gree   t hat   p articipation   i n   a ny   Y oga   E xercises   c ould   c onstitute   a   r isk   o f   s erious   i njury   t o   m yself.   I   w illingly   a nd   k nowingly   a ccept   t his   r isk  
and   g ive   a ssurance   t hat   I   a m   p hysically   f it   a nd   a ble   t o   p erform   Y oga   E xercises.  
I   u nderstand   a nd   a gree   t hat   L iving   Y oga,   t heir   d irectors,   e mployees,   s taff,   v olunteers   a nd   s ponsors   a re   n ot   l iable   f or,   n or   e xpected   t o   p rovide   a ny   a dvice,  
training   o r   m edical   a ssistance.  
I   a gree   t hat   t he   c harity   I   h ave   e lected   t o   s upport   m ay   p rovide   t he   o rganizers   w ith   d etails   o f   t he   a mount   o f   s ponsorship   I   h ave   r aised   a nd   t his   f igure   m ay   b e  
publicized   o n   t he   L iving   Y oga   a nd   Y ogathon   w ebsite.  
I   a gree   t hat   t he   o rganizers   m ay   h old   m y   c ontact   d etails   o n   t heir   r ecords   t o   i nform   m e   o f   s ubsequent   c harity   e vents   b eing   h eld   a nd   t hat   t hese   d etails   w ill  
not   b e   p assed   o n   t o   a ny   o ther   t hird   p arty,   o rganization,   c ompany   o r   i ndividual.  
I   g ive   p ermission   f or   m y   p hotograph   o r   v ideo   i mage   t o   b e   u sed   f or   m edia   p urposes   i n   t his   a nd   a ny   f uture   e vents.   I   w aive   a ny   c laim   a nd   r ight   t o   i nspect   t he  
photographs   a nd   a ny   a dvertising   o r   p romotional   c opy   t hat   m ay   b e   u sed   i n   c onjunction   w ith   t he   e vent.  
 
LIVING   Y OGA   Y OGATHON   E VENT   W AIVER,   R ELEASE   a nd   I NDEMNIFICATION   F ORM  
For   m yself,   m y   e xecutors,   a dministrators,   h eirs,   n ext   o f   k in,   s uccessors   a nd   a ssigns.     I   H EREBY:  
a.
Waive   a nd   r elease   a ny   a nd   a ll   c laims   t hat   I   m ay   h ave   a gainst   L iving   Y oga,   t heir   d irectors,   e mployees,   s taff,   v olunteers,   a gents   a nd   a ny   o ne   o r   m ore   o f   t hem  
or   t heir   e xecutors,   a dministrators,   h eirs,   n ext   o f   k in,   s uccessors   a nd   a ssigns   ( "the   r eleasees")   i ncluding   a ny   a nd   a ll   c laims   f or   d amage   c aused   b y   t he  
negligence   o f   a ny   o f   t hem,   a rising   o ut   o f   m y   p articipation   i n   t he   e vent   a nd   i ts   r elated   a ctivities,   t ogether   w ith   a ny   c osts   i ncluding   l awyers'   f ees   t hat   m ay   b e  
incurred   a s   a   r esult   o f   a ny   s uch   c laim   w hether   v alid   o r   n ot,   a nd  
b.
Indemnify   a nd   h old   h armless   t he   r eleasees   a nd   e ach   o f   t hem   a gainst   a ny   s uch   c laim   t hat   I   o r   m y   g uests   o r   a ny   o ne   o r   m ore   o f   m y   o r   t heir   e xecutors,  
administrators,   h eirs,   n ext   o f   k in,   s uccessors   a nd   a ssigns   m ay   h ave   o r   a ssert   a nd   a gainst   a ny   c osts   i ncluding   l awyers'   f ees   w ith   r espect   t hereto.  
c.
I   h ereby   a cknowledge   t hat   p articipation   i n   t he   L iving   Y oga   Y ogathon   e vent   c arries   w ith   i t   p otential   h azards.   I   t herefore   r elease   L iving   Y oga,   t heir   d irectors,  
employees,   s taff,   v olunteers   a nd   s ponsors   o f   a ny   l iability   r esulting   f rom   i njury   o r   d eath   d uring   t he   e vent   a nd   i ts   r elated   a ctivities.  
 
 
 
 
                                              S ignature                                                                                                                                                                                                                                                                       D ate  

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