I, (parent/guardian or adult ) having been informed of the above designated activity sponsored by the City of Whiteville, Columbus County Arts Council, Columbus County Chamber of Commerce & Tourism, Columbus County Department of Public Health, Columbus Regional Healthcare System, and Southeastern Community College, do herewith request that said person be accepted as a participant in said activity.
In permitting the participant to participate, I am specifically granting my permission to the sponsors to use the likeness, name, voice and words in television, radio, film, newspapers, magazines and other media, and in any form, for the purpose of advertising or communicating the purposes and activities of each sponsor.
If a medical emergency should arise during the participant’s participation in the Holiday Haber”DASH”ery 2-Mile Holiday Costume Fun Run/Walk, at a time when I am not personally present so as to be consulted regarding the participant’s care, I hereby authorize the sponsors as they deem advisable in order to protect the participant’s health and well-being.
I, the undersigned, am parent, guardian, participant (own guardian), of the below specified person. I have read and fully understand the provisions of the above release and have explained them to that person. I hereby agree that said person and I will be bound thereby and shall defend the sponsors and hold the sponsors harmless for any disaffirmation thereof by said person.
I hereby give my permission for:
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