Colorado Society for Respiratory Care » 2012 Roll N Walk » Colorado Society for Respiratory Care

2012 Roll N Walk

2012 Annual Roll N Walk
June 9, 2012 9am
Clement Park, Shelter #5
Littleton, Colorado 80123

A walk to promote respiratory disease awareness and raise funds for the CSRC Student and Patient Chapters. This is an interactive event with respiratory patients, respiratory therapists, and respiratory therapy students.

Registration fee of $20 covers brunch, a commemorative t-shirt, and a chance to win prizes!

Participant Description *

Patient Participant

Respiratory Student Participant

Respiratory Care Practitioner Participant

Family Member

Sponsor

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone

Email *

Please select one of the following *

$20 Participant

$50 Sponsor

Please read the waiver of liability and check "agree" below to participate in this event

RELEASE OF LIABILITY

READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS

In exchange for participation in the activity of Roll-n-Walk organized by Colorado Society for Respiratory Care (CSRC and/or CSRC Student Chapter), of P.O. Box 3854, Englewood, Colorado, 80155 and/or use of the property, facilities, facilities used by, and services of CSRC and/or CSRC Student Chapter, I agree for myself and (if applicable) for the members of my family, to the following:

1. I agree to observe and obey all posted rules and warnings and further agree to follow any oral instructions or directions given by CSRC and/or CSRC Student Chapter, or the employees, representatives or agents of CSRC and/or CSRC Student Chapter.

2. I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge CSRC and/or CSRC Student Chapter for my injury, loss or damage arising out of my or my family's use of or presence upon the facilities or facilities used by the CSRC and/or CSRC Student Chapter, whether caused by the fault of myself, my family, CSRC and/or CSRC Student Chapter or third parties.

3. I agree to indemnify and defend CSRC and/or CSRC Student Chapter against all claims, causes of action, damage, judgments, cost or expenses including attorney fees and other litigation costs, which may any way arise from my or my family's use of or presence upon the facilities or facilities used by CSRC and/or CSRC Student Chapter.

4. I agree to pay for all damages to the facilities or facilities used by CSRC and/or CSRC Student Chapter caused by my or my family's negligent, reckless or willful actions.

5. Any legal or equitable claim that may arise from participation in the above shall be resolved under Colorado law.

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND BY CHECKING THE BOX BELOW, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

After reading the waiver above please indicate "agree" in order to participate in this event *

Agree

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