Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Registration Fee of $60 *

I have sent the registration fee of $60 to the GO FUND ME fundraising page: https://gofund.me/9e1fa414

Paid

Event Waiver *

Waiver of Liability, Indemnity Agreement and Assumption of Risk for Lift for Pride I,_________________________________, agree and consent to the following: I am voluntarily participating in the Lift for Pride Deadlifting event at Ethos Fitness and Performance. I recognize that this event requires physical exertion that may be strenuous at times and may cause physical injury and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the above-mentioned event. I represent and warrant that I have no medical condition that would prevent my participation in the workout. I agree to assume full responsibility for any risks, injuries or damage known or unknown which I might incur as a result of participating in the workout. Such injuries may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness, including death. I knowingly, voluntarily, and expressly waive any claim I may have against Michelle Farrell, Justice Williams, or Jess McCutheon-Schour for injury or damages that I may sustain as a result of participating in the event. I, my heirs or representatives forever release, waive, discharge, and covenant not to sue Michelle Farrell, Justice Williams, or Jess McCutheon-Schour for any injury or death caused by their negligence or other acts. I have read the above waiver and release of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

I agree

Photo and Video Release *

Photo/Video Release We will be taking photos and videos throughout this event! By registering for Lift for Pride, the participant grants Michelle Farrell, Justice Williams, and/or Jess McCutheon-Schour permission to use his/her/their likeness in photograph(s) and/or video(s) in any and all publications and materials without payment or consideration made to them. The event participant authorizes Michelle Farrell, Justice Williams, or Jess McCutheon-Schour to use, edit, copy, publish or exhibit any photo or video for any lawful purpose such as their websites and/or social media fr the promotion and celebration of Lift for Pride.

I agree