Waiver Form
WAIVER AND RELEASE OF LIABILITY

In consideration of the risk of injury while participating in Lend An Ear, Save a Life Run (the
"Activity"), and as consideration for the right to participate in the Activity, I hereby, for myself, my
heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily
enter into this waiver and release of liability and hereby waive any and all rights, claims or causes
of action of any kind whatsoever arising out of my participation in the Activity, and do hereby
release and forever discharge Miss United Hmong Michigan Court, Hmong Wausau Festival or
Hmong American Center Inc., located at 602 E Kent St, Wausau, Wisconsin 54403, their affiliates,
managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors,
successors and assigns, for any physical or psychological injury, including but not limited to
illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct
result of my participation in the aforementioned Activity, including traveling to and from an event
related to this Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM
PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE
RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN
THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR
PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY
OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL
LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE
FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE
CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED
RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY,
INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY.

I agree to indemnify and hold harmless Miss United Hmong Michigan Court, Hmong Wausau
Festival or Hmong American Center Inc. against any and all claims, suits or actions of any kind
whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my
behalf, including attorney's fees and any related costs, if litigation arises pursuant to any claims
made by me or by anyone else acting on my behalf. If Miss United Hmong Michigan Court,
Hmong Wausau Festival or Hmong American Center Inc. incurs any of these types of expenses, I
agree to reimburse Miss United Hmong Michigan Court, Hmong Wausau Festival or Hmong
American Center Inc.

I acknowledge that Miss United Hmong Michigan Court, Hmong Wausau Festival or Hmong
American Center Inc. and their directors, officers, volunteers, representatives and agents are not
responsible for errors, omissions, acts or failures to act of any party or entity conducting a
specific event or activity on behalf of Miss United Hmong Michigan Court, Hmong Wausau
Festival or Hmong American Center Inc.

I ACKNOWLEDGE THAT THIS ACTIVITY MAY INVOLVE A TEST OF A PERSON'S
PHYSICAL AND MENTAL LIMITS AND MAY CARRY WITH IT THE POTENTIAL FOR DEATH,
SERIOUS INJURY, AND PROPERTY LOSS. The risks may include, but are not limited to, those
caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants,
equipment, vehicular traffic and actions of others, including but not limited to, participants,
volunteers, spectators, coaches, event officials and event monitors, and/or producers of the
event.

I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND

FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO
RELEASE AND DISCHARGE Miss United Hmong Michigan Court, Hmong Wausau Festival
or Hmong American Center Inc. AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS,
AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES,
PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR
CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT
THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST Miss United Hmong
Michigan Court, Hmong Wausau Festival or Hmong American Center Inc. FOR PERSONAL
INJURY OR PROPERTY DAMAGE.

To the extent that statute or case law does not prohibit releases for negligence, this release is
also for negligence on the part of Miss United Hmong Michigan Court, Hmong Wausau Festival or
Hmong American Center Inc., its agents, and employees.

In the event that I should require medical care or treatment, I agree to be financially responsible
for any costs incurred as a result of such treatment. I am aware and understand that I should
carry my own health insurance.

In the event that any damage to equipment or facilities occurs as a result of my or my family's
willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all
costs associated with any actions of neglect or recklessness.

This Agreement was entered into at arm's-length, without duress or coercion, and is to be
interpreted as an agreement between two parties of equal bargaining strength. Both the
Participant and Miss United Hmong Michigan Court, Hmong
Wausau Festival or Hmong American Center Inc. agree that this Agreement is clear and
unambiguous as to its terms, and that no other evidence will be used or admitted to alter or
explain the terms of this Agreement, but that it will be interpreted based on the language in
accordance with the purposes for which it is entered into.

In the event that any provision contained within this Release of Liability shall be deemed to be
severable or invalid, or if any term, condition, phrase or portion of this agreement shall be
determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall
remain in full force and effect, so long as the clause severed does not affect the intent of the
parties. If a court should find that any provision of this agreement to be invalid or unenforceable,
but that by limiting said provision it would become valid and enforceable, then said provision shall
be deemed to be written, construed and enforced as so limited.
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Emergency Contacts. Please list TWO (2) (Name, Relationship, Telephone Number) *
Consent
I, the undersigned participant, affirm that I am of the age of 18 years or older, and that I am freely signing this agreement. I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am signing it of my own free will.
Name *
Address *
Signature & Date *
PARENT / GUARDIAN WAIVER FOR MINORS
In the event that the participant is under the age of consent (18 years of age), then this release must be signed by a parent or guardian, as follows:

I hereby certify that I am the parent or guardian of the individual named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual.
Parent/Guardian Name
Relationship to Minor
Signature & Date
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