What's your full name? *

 
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Please select your age range. *


 
What is your address? *

 
What is your phone number? *

 
Waiver and Release Form
Please Read Carefully *

ASSUMPTION OF RISK, RELEASE AND PERMISSION

Walk to Set Free involves walking - an activity which may include risks such as, but not limited to, falls, interaction with other participants, effects of weather, traffic and conditions of the road or sidewalk. In consideration of being allowed to participate in this event, I {{answer_26064141}} hereby expressly assume all risks, including bodily and personal injury, death, property loss or other damages of any kind arising in any way out of my attendance or participation in the Walk to Set Free and related activities.It is my responsibility to dress appropriately. Although route maps, rest stops, refreshments, and other assistance may be made available during this event, I {{answer_26064141}} am solely responsible for my own health and safety. I {{answer_26064141}} represent that I am physically fit and able to attend or participate in this event.I {{answer_26064141}} hereby for myself, my heirs, executors and administrators, release, discharge and agree not to sue The Dubuque Justice League DBA Set Free Dubuque, their respective officers, directors, volunteers, employees, sponsors and agents, from any and all liability, claims, demands and causes of action whatsoever, arising out of my participation in or attendance at this event and related activities whether resulting from the negligence of any of the above or from any other cause.I {{answer_26064141}} agree that my assumption of risk and release here under shall be as broad and inclusive as is permitted under applicable law. If any portion of this agreement is held invalid, the remainder shall continue in full force and effect.I {{answer_26064141}} grant full permission in perpetuity to the organizers of this event to use, re-use, publish and re-publish my name and image as a participant in the event in photographs, video or other recordings.

I {{answer_26064141}} have read, understand and agree to the terms of this agreement. Click "I accept" if you have read and agree to these terms and conditions. 

NOTE: All participants under 18 must have a parent or legal guardian sign this waiver on their behalf during check in the day of walk.  No minor may participate in the walk if this is not completed. We appreciate your cooperation and understanding.
     
 
I would like to receive future notifications on updates and events from Set Free. *

     
 
How did you hear about the walk? *


 
Thank you for your registration for the Walk to Set Free. Please allow 24-48 hours for a confirmation email and more information regarding the Walk to Set Free event.

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