_________________________________
Event Name
Name (first, last) ____________________________________________
Address (Street, City, etc.) ____________________________________
Telephone ___________________Email _________________________
Age ________ Event ________________________________________
[ ] Yes [ ] No - Membership dues paid? [ ] Annual-$75 [ ] One day-$25
[ ] Yes [ ] No - Would you like to receive the monthly email newsletter?
Release of All Claims
- I understand that this Club Fat Ass Event (“CFA Event”) is physically challenging and hazardous for even well-conditioned and prepared athletes under favorable conditions.
- I acknowledge and understand that participation in this CFA Event involves risks to my health and safety, including permanent injury or death, and I voluntarily assume those risks.
- I understand and acknowledge that neither Club Fat Ass nor my CFA Event Host is responsible for assessing my ability to participate in this CFA Event and I have had made such inquiries as are reasonably necessary concerning this CFA Event to be able to declare that I am healthy and fit for this CFA Event.
- I understand that neither Club Fat Ass nor my CFA Event Host provides participants accident, disability or other insurance and that I am solely responsible for providing such coverage as I deem necessary or prudent.
In consideration for being permitted to participate in this CFA Event, I hereby for myself and for my personal representatives and successors release and forever discharge my CFA Event Host and Club Fat Ass, together with the officers, directors, employees, representatives, agents, sponsors and volunteers of each, of and from all actions, causes of action, claims, demands or compensation of any kind, whether presently known or unknown, and whether as a result of negligence or any other cause, arising out of or in connection with my participation in this CFA Event.
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--- Event Guest (signature) -------------------------- Date ---------------------
