Healthy Heart Initiative, Inc

Run/Walk 100Km Challenge

Healthy Heart Initiative Release and Disclaimer

Name: _______________________

Address: __________________________________________________

Email: ________________________

Phone: _______________________

This Release and Waiver of Liability (the “Release”) executed by the “participant” in favor of Healthy Heart Initiative, a non-profit corporation organized and existing under the laws of the State of Massachusetts, USA, its directors, officers, employees, volunteers, and agents (collectively, “HHI”).

I, the Participant, desire to participate in an HHI activity in a volunteer capacity or as a participant andengage in the activities related to being a participant in the following activity: Run/Walk 100 Km challenge in one month. I hereby freely and voluntarily, without duress, execute this Release under the following terms.

1.    Waiver and Release. I, the participant, release and forever discharge and hold harmless HHI from anyclaim or liability that I, the Participant, may have against HHI with respect to any bodily injury, personalinjury, illness, death, or property damage that may result from the participation with an activity. I also understand that HHI does not assume any responsibility for or obligation to provide financial assistance or other assistance, including, but not limited to medical, health or disability insurance, in the event ofinjury, illness, death or property damage (see insurance requirements below).

2.    Insurance. I, the Participant, understand that HHI does not carry or maintain, and expressly disclaims responsibility for providing any health, medical or disability coverage for the Participant.

3.    Medical Treatment. Except as otherwise agreed to by HHI in writing, I hereby release and foreverdischarge HHI from any claim whatsoever which arises or may hereafter arise on account of anyfirst-aid treatment or other medical services rendered in connection with an emergency during mytime with HHI.

4.    Assumption of Risk. I understand that my time with HHI may include activities that may be hazardous to me, including, but not limited to, construction activities, loading and unloading or heavyequipment and materials, and local transportation to and from the event sites. So, I recognize andunderstand that my time with HHI may, in some situations, involve inherently dangerous activities. Ihereby expressly and specifically assume the risk of injury or harm in their activities and release HHIfrom all liability for injury, illness, death, or property damage resulting from the activities of my timewith HHI.

5.    Photographic Release. I hereby grant to HHI, its legal representatives, successors and assigns,irrevocable permission to take and to copyright, in its own name or otherwise, and re-use, publish and republish photographic portraits, pictures or similar images of likenesses (collectively, the “Pictures) ofme and my children and/or other minors for which I am legally responsible, including, without limitation,any other Pictures in which I or they may be included, in whole or in part, composite or distorted incharacter or form, without restriction as to changes or alternations, in conjunction with my own or fictitious name(s), or reproductions thereof in color or otherwise, made through any medium, and in anyand all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, and any other purpose whatsoever. I also consent to the use of any published matter in connectiontherewith. The Pictures may be published in any manner, including advertising, periodicals, trade showexhibits and other promotional applications. Furthermore, I will hold harmless HHI, its representatives,successors, and assigns, from any liability arising from or in connection with the aforementionedPictures.

6.    Other. If there is any violation of this agreement and HHI is sued, or a claim is made against HHI, Iagree to indemnify HHI and hold them harmless from any and all expense and liability. Such indemnityshall cover all reasonable expenses incurred by them, including, but not limited to attorney fees.

I HAVE CAREFULLY READ THIS ASSUMPTION OF RISK, RELEASE OF LIABILITY, AND RELEASE AGREEMENT AND I FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASEOF LIABILITY AND A CONTRACT BETWEEN ME AND HHI.

Signature of Participant:  _______________________                                                                                                      

Date:_____________________