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Captain’s Details
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By checking the "I Agree" box below and clicking Submit, I understand that I am digitally signing this form and consenting to this WAIVER and each of its terms listed below. If the participant is under 18, I certify that I am the legal parent or guardian of the participant. If the participant is an adult, I certify that they are a member of my family and I have their authorization to consent to this waiver on their behalf.

WAIVER: In consideration of my participation in the 2016 STOP FOR NIKHIL Run/Walk, to be held on Sunday, September 18, 2016 ('Event'), I for myself, and on behalf of my Family, heirs and all assigns, release and hold harmless The Nikhil Badlani Foundation, Inc., and/or any other sponsors, organizers and volunteers and their assigns, successors and heirs from any and all liability, loss, including any injury/death to any person; damage, expense, cost of every nature, and any cause of action (including negligence) arising from and in connection with my participation in this Event. I certify that I am in good health and able to participate in this Event. If I need emergency medical treatment, as a result of participation in this 'Event', I agree to be financially responsible for any costs incurred as a result of such treatment. I am voluntarily participating in this Event, and I acknowledge and willingly assume the risk of any possible injury, death or damage that may be sustained by me as a result of participation in this Event. Further, I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, and any other record of this event for purposes of promoting Event or The Nikhil Badlani Foundation.

I Agree