Lub Dub Waiver Statement

In consideration of this entry being accepted, I (and any additional registrants that I process) hereby for myself (and my additional registrants), heirs, executors and administrators waive and release any claims that I may have against Bothwell Regional Health Center Foundation, Bothwell Regional Health Center, Ultramax Timing System or any of the sponsors involved in the Lub Dub Run/Walk. I certify that I am physically able to participate in this event.

I (and any additional registrants that I process) give permission to Bothwell Regional Health Center Foundation and Bothwell Regional Health Center to use my (our) photographic image for advertising, media, or other purposes, and consent to use my (our) name(s) in connection with this image.

I accept