Volunteer Waiver
Sample Event
Join us on sample date
Join us on sample date
WAIVER AND MEDIA RELEASE AUTHORIZATION
In consideration of the acceptance of my participation in the “2019 Heart of the City 5K Walk/Run, on Saturday, March 30, 2019, I the undersigned, hereby release and hold harmless, California Hospital Medical Center, California Hospital Medical Center Foundation, Dignity Health, and all of their sponsors, their affiliates, agents, servants, employees, volunteers, assigns, successors and heirs and all officials concerned for all acts, omissions, negligence, which may result in any bodily injury (including death) and/or property loss or damage incurred by me arising out of or in connection with my participation in this event. I warrant that I am in good health and have trained sufficiently for this event. I willingly assume any risk inherent in entering this event. This waiver extends to all claims of any kind and nature whatsoever, whether known or unknown.
Furthermore, I permit and grant to the event promoters full and exclusive right to record my performance in said event on film, videotape, photographs, motion pictures, recordings, or any other record of this event for legitimate purposes without compensation. This authorization permits the use and/or disclosure of my photo, video and digital/audio recording, name, location, work or participation results. Authorized users include California Hospital Medical Center Foundation staff, California Hospital Medical Center Public Relations Department staff, and California Hospital Medical Center Administrative Department staff. I hereby authorize the information to be used and or disclosed in media stories, in California Hospital Medical Center newsletters, or next year’s event promotion. I understand that I have the right to revoke this Authorization at any time, provided that my revocation is in writing and conforms to requirements described in (California Hospital Medical Center) Notice of Privacy Practices, a copy of which is available online at www.dignityhealth.org/privacy or in person at California Hospital Medical Center. I understand that my revocation will be effective upon its receipt by the person(s) I authorized above, but would not be effective to the extent that such persons have acted in accordance with this Authorization and in reliance thereon.
In consideration of the acceptance of my participation in the “2019 Heart of the City 5K Walk/Run, on Saturday, March 30, 2019, I the undersigned, hereby release and hold harmless, California Hospital Medical Center, California Hospital Medical Center Foundation, Dignity Health, and all of their sponsors, their affiliates, agents, servants, employees, volunteers, assigns, successors and heirs and all officials concerned for all acts, omissions, negligence, which may result in any bodily injury (including death) and/or property loss or damage incurred by me arising out of or in connection with my participation in this event. I warrant that I am in good health and have trained sufficiently for this event. I willingly assume any risk inherent in entering this event. This waiver extends to all claims of any kind and nature whatsoever, whether known or unknown.
Furthermore, I permit and grant to the event promoters full and exclusive right to record my performance in said event on film, videotape, photographs, motion pictures, recordings, or any other record of this event for legitimate purposes without compensation. This authorization permits the use and/or disclosure of my photo, video and digital/audio recording, name, location, work or participation results. Authorized users include California Hospital Medical Center Foundation staff, California Hospital Medical Center Public Relations Department staff, and California Hospital Medical Center Administrative Department staff. I hereby authorize the information to be used and or disclosed in media stories, in California Hospital Medical Center newsletters, or next year’s event promotion. I understand that I have the right to revoke this Authorization at any time, provided that my revocation is in writing and conforms to requirements described in (California Hospital Medical Center) Notice of Privacy Practices, a copy of which is available online at www.dignityhealth.org/privacy or in person at California Hospital Medical Center. I understand that my revocation will be effective upon its receipt by the person(s) I authorized above, but would not be effective to the extent that such persons have acted in accordance with this Authorization and in reliance thereon.
