Breast Cancer Awareness Walk

I hereby give Crawford County Memorial Hospital (“CCMH”) consent to record, videotape and photograph my image and/or voice to be used for marketing, advertising and other information CCMH deems necessary.

I further understand that no special compensation will be provided to me for use of my image and that I may not be informed in advance of the specific use of my image.

I understand that participation in the CCMH Breast Cancer Awareness Walk is a voluntary activity and involves inherent risks, including but not limited to falls, slips, collisions with other participants, uneven surfaces, physical exertion, allergic reactions, respiratory irritation, or other injuries or medical conditions that may occur before, during, or after the event.
I certify that I am physically able to participate in the CCMH Breast Cancer Awareness Walk and understand that I am participating at my own risk.
To the fullest extent permitted by law, I agree that Crawford County Memorial Hospital, its employees, officers, directors, volunteers, representatives, sponsors, and affiliates, shall not be held responsible or liable for any injury, illness, loss, damage, or other claim arising from or related to my participation in the CCMH Breast Cancer Awareness Walk.
I voluntarily assume all risks associated with my participation and agree to release and hold harmless CCMH and the parties listed above from claims arising from my participation in the event, to the fullest extent permitted by law.
I understand that I am responsible for determining whether I am physically fit and able to participate. I agree to stop participating if I experience pain, illness, dizziness, difficulty breathing, or any other concerning symptoms and to seek medical attention if necessary.