Transcript BAL VIHAR 5K WALK/RUN April 6, 2014 Millennium Park, Creve

International Day of Yoga
June 21st 2015
Sun Salutations Challenge
Registration Form:
Participant 1: _________________
Participant 3: _________________
Participant 5: _________________
Participant 2: _________________
Participant 4: _________________
Participant 6: _________________
WAIVER AND RELEASE
I hereby declare, assert and affirm that my participation in the Center of Indian Cultural Education, Bal Vihar of
St. Louis, International Day of Yoga, Sun Salutations Challenge is done voluntarily and knowingly, assuming
ALL RISKS involved in this Event. I hereby certify the following: I am physically fit and have received medical
clearance to participate in the Sun Salutations Challenge. I recognize that the immediate physical risks and
hazards associated with normal, vigorous physical activity include (but are not limited to) physical discomfort,
fatigue, muscular soreness, falls, pulled or strained muscles, overuse injuries, heat stress, and the rare instance
of abnormal responses of the cardiorespiratory system including heart arrhythmia, heart attack, stroke, and
sudden death. If I do participate, I, on behalf of myself, my heirs and assigns, and my estate, hereby Waive and
Release and forever discharge the sponsors, organizers, affiliates specifically Center of Indian Cultural
Education, Bal Vihar of St. Louis, their respective volunteers, as well as their agents and employees, from any
and all claims that may occur as a result of my participation. I hereby give my permission to the event
organizers and sponsors to use my name and/or picture in any publication, broadcast, telecast or other account
of this event without limitation or obligation of further compensation thereof. By signing this waiver and release I
certify that I fully understand its significance.
_______________________________ Date _________ / _____________________________ Date_________
Participant #1 signature
If under 18, Parent or Guardian’s signature
_______________________________ Date _________ / _____________________________ Date_________
Participant #2 signature
If under 18, Parent or Guardian’s signature
_______________________________ Date _________ / _____________________________ Date_________
Participant #3 signature
If under 18, Parent or Guardian’s signature
_______________________________ Date _________ / _____________________________ Date_________
Participant #4 signature
If under 18, Parent or Guardian’s signature
_______________________________ Date _________ / _____________________________ Date_________