5k Registrant Information

Please fill out the form below.

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Please fill out the form below by April 15, 2019.

In Motion: 5K Run, Walk, Fun – 2019 Waiver & Release Terms

I acknowledge that my participation in the 5K Run, Walk, Fun involves a risk of injury, including bodily injury, and assume the risk for same. On my own behalf and on behalf of my heirs and legal representatives and to the fullest extent permitted by law, I hereby release and discharge ADHA and The ADHA Institute for Oral Health and their respective directors, officers, employees, affiliates, members, agents and representatives, of and from any and all liability for injury, death, or damages and/or any other claims, demands, losses or damages, incurred by me in connection with any aspect of the 5K.

If an employee of ADHA, I acknowledge that my participation in the 5K is completely voluntary and does not constitute part of my work-related duties. I understand that my decision to participate, or not participate, in this activity will not affect my job status.