Veteran’s Day 5K

he signee and the legal sponsor of individuals identified on this form, does hereby, and as an inducement to the FMWR at Richmond, allow the use of, participation in, or involvement with FMWR facilities, equipment, services, or programs. The undersigned does hereby forever release, acquit, and discharge FMWR at Richmond, and the United States Government from all cause or causes of action. This includes personal injury, illness, death, property damage, cost, charges, claims, demands, and liabilities of whatever kind, name or nature in any manner arising out of the use, enjoyment, and control over participation, or involvement in or with equipment, services, or programs. This release is intended to cover all injuries, fatal or nonfatal, and illness of every name, kind or nature, and personal property damage. If any, which may be or might not be, sustained or suffered from any cause whatsoever connected, or arising out of, or by reason of the use of, participation in, or involvement with FMWR facilities, equipment, services, or programs. The undersigned further agrees to pay for the cost of possible future damage, loss, or injury, and will hold harmless the FMWR Fund and the United States Government from all cost, charges, claims, demands, and liabilities of any kind arising from improper or negligent use of, participation in, or involvement with FMWR facilities, equipment, services, or programs. Privacy Act Statement Authority to Collect Information: 50 U.S.C., Section 797, Penalty for Violation of Security Regulations and Orders; 5 U.S.C. Sections 301 and 302(b), Government Organization and Employees; Executive Orders 9397 and 10450, as amended; DOD D5200.8; and DLA M5710.1 Principal Purpose: To collect, review, and account for patronage data. It is also used to grant authorized individuals access to FMWR equipment and facilities. Routine Uses: It is used to establish and automate MWR activity registration, reservation, and to substantiate capital reinvestment in facilities. Information may also be used to establish and maintain a numerical identifier for each patron household. Mandatory or Voluntary Disclosure: Voluntary; Result if Information is not Provided: May result in delayed customer service at FMWR activities or loss of access to equipment and facilities. I agree to the terms of this Hold Harmless Agreement. Note: If participant is under 18 years of age this Hold Harmless Agreement must be signed by the parent or legal sponsor at the Event.