Official Registration Form and Waiver & Release for Regent University’s
Christian Legal Society (CLS) 5K RACE FOR GLOBAL JUSTICE
Event date: April 1, 2012
Each and every participant must complete this form, including signing and initialing his or her own
form before turning into registration.
1. Full Name (Last, First):
2. E-mail:
3. Phone #:
4. Gender:
5. T-shirt size (choose ONE preference)
Female – XS, S, M, L:
Male/ Unisex – S, M, L, XL:
*sizes are subject to availability; free shirts until supply runs out with priority to early registrants!
4. Affiliation (Student, alumni, faculty, other):
Waiver & Release Agreement:
(1) I,
, a participant, hereby voluntarily, fully and completely
release and shall indemnify, defend and hold harmless any and all liability of Regent University and its
governing board, faculty members, agents, employees, student organization leaders, members from
any and all liability, claims, actions, injury or harm to me, or from damage to my property. I
understand that this Agreement covers liability, claim, and actions caused entirely or in part by any
act or failure to act by Regent University (or its board, faculty, employees or agents) and Christian
Legal Society (or its affiliates), including, but not limited to negligence, mistake or failure due to
supervise by Regent University or Christian Legal Society (or its affiliates, including, but not limited to
its leadership, volunteers, students, members, associates); whereby I, by participating in the Christian
Legal Society (CLS) 5k Race for Global Justice, take and accept full responsibility and complete liability
for myself; I knowledgeably and voluntarily waive any and all rights to sue or indemnify Regent
University and or any of its affiliates, as it shall be construed under the laws of the Commonwealth of
Virginia.
(2) As a parent or guardian of a participant in this event (CLS 5k Race for Global Justice), I agree to the terms
and conditions contained in this agreement, and I assume responsibility for the actions or inactions of the
participant.
(3) This Release and Waiver shall be construed under the laws of the Commonwealth of Virginia and I agree to
submit any claims hereunder or otherwise arising out of the Program to binding arbitration in Virginia Beach,
Virginia, under the rules of the American Arbitration Association. Each party shall bear its own expenses in
such arbitration.
(4) I have read this entire Agreement. I fully understand it, and I agree to be legally bound by it. No oral
representations, statements or inducements have been made with regard to this Agreement or the
Assignment.
Name (please print):________________________________________________
Signature:____________________________________________Date:___________
--or-Name (of participating minor):________________________________________________
Name & Signature of parent or legal guardian of participating minor:
Name:____________________________________________
Signature:____________________________________________Date:___________
5. Payment:
I,
(please print) agree to pay $15, $20, or $25 during registration for
this event and waive any right to reimbursement or transfer of this monetary amount given at time of
registration.
X:________________________ (participant signature or signature of parent or legal guardian of
participating minor).