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).