ALL▴TRI Participant Liability, Consent, and Information Release
I, intending to be legally bound, understand that I am voluntarily participating in the ALL TRI, Inc. (ALL▴TRI) philanthropy and fitness training program (the Program) and all of its activities including, but not limited to, training for and participating in with the Capital of Texas Triathlon (Sprint or Olympic) on May 28, 2012, or the US Open Toyota Cup Triathlon (Sprint or Olympic) on October 7, 2012, (collectively, the Event) at my own request and at my own risk. I acknowledge that I am aware of the risks inherent in training for and participating in the Event and certify that I am physically fit, have not been otherwise informed by any physician and know no restriction imposed on me by any physician that would in any way prevent me from actively participating in the Event.
In consideration of ALL▴TRI′s sponsorship of this Event and my being permitted to participate in the Event, I, on behalf of myself, my successors in interest, heirs, assigns, and representatives, herby fully release and hold harmless ALL▴TRI and its Officers, Trustees, agents, employees, volunteers, and any medical providers working for or on behalf of the Program, and representatives, successors, and assigns (be they individuals or organizations), together with their insurers and sponsors, (collectively, the Organization), of and from any and all liability, claims, damages, actions, and cause of action whatsoever on account of any loss, damage, or injury to person (including death) or any other loss or inconvenience whatsoever, suffered by me at any time hereafter arising out of my voluntary participation in this Event, whether resulting from the Organization′s negligence or otherwise (collectively, Liabilities).
I also give permission to the Organization for the free use of my name, image and voice in any broadcast, telecast, print account, or any other account in any medium of this Event (the Personal Release).
Consent & Information Release (Consent): I hereby grant permission to the Organization to render preventative or first-aid assistance or seek treatment or medical care that seams reasonably necessary, including hospitalization, for my health and well being. I also give permission to the Organization to use and disclose my personal health information (PHI) in the ways described in this form. I allow the Organization to use my PHI as necessary for purposes related to my treatment. I also all the Organization to give out my PHI to doctors, hospitals, ambulance companies, coaches, family members, and others involved in my care and treatment. My PHI may also be used and given out as necessary for the proper management and administration of the Organization.
This Release & Consent will be governed by and subject to the laws (except the choice of law principles) and exclusive jurisdiction of the courts of the State of Texas.
