To benefit Cardiology Services at Henry Medical Center


Online Application

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IN CONSIDERATION OF THE ACCEPTANCE OF THIS ENTRY, THE UNDERSIGNED, AND FOR HIS OR HER HEIRS, SUCCESSORS AND ASSIGNS, (1) HEREBY WAIVES ANY AND ALL CLAIMS AGAINST THE SPONSORS AND OFFICIALS OF THE PACEMAKER 5000 RUN FOR INJURIES, ILLNESS OR DAMAGES WHICH MAY RESULT DIRECTLY OR INDIRECTLY FROM MY PARTICIPATION; AND (2) EXPRESSLY RELEASES SAID OFFICIALS AND SPONSORS FROM ANY AND ALL SUCH CLAIMS FOR INJURY, ILLNESS OR DAMAGE RESULTING THEREFROM. THE UNDERSIGNED AFFIRMS THAT HE OR SHE IS IN PROPER CONDITION TO PARTICIPATE IN THE EVENT.