Please be advised that this information is being sent by means of an unsecured transmission and that it is possible-although unlikely-that any or all of this information could be intercepted by third parties while in transmission. St. Barnabas Health System assumes no liability for any damages that may arise from such unauthorized interception. If you would prefer not to transmit this information via the Internet, please leave the credit card information blank and we will contact you via phone or conventional mail.

Waiver:

_______________________________________________________________
Signature of parent or guardian (required if applicant is under 18 years of age)

In consideration of your accepting this entry, I the above signed, intending to be legally bound, hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against St. Barnabas Health System and any other sponsors and their representatives, successors and assigns for any and all injuries suffered by me in said event. I attest that I will participate in this event, that I am physically fit and sufficiently trained for the completion of this event. Further, I hereby grant full permission to use my name and any likeness, as well as any photographs or any record of this event in which I may appear for any legitimate purpose, including advertising and promotion.