I represent and warrant that to the best of my knowledge and belief, that I am physically and mentally able to participate in this COLUMBUS POLICE DEPARTMENT’S Georgia Special Olympics Torch Run (“the Event”), to be held on Thursday, May 15, 2025. I represent that there is no medical evidence which would preclude me from participating in this community event.

The COLUMBUS POLICE DEPARTMENT has my permission (both during and any time after), to use my likeness, name, voice, or words in either television, radio, film, newspapers, magazines, and other media and in any form, for the purpose of advertising or communicating the purposes and activities of the COLUMBUS POLICE DEPARTMENT and/or applying for funds to support those purposes and activities.

If during my participation in the Event, I should need emergency medical treatment, and I am not able to give my consent or make my own arrangements for that treatment because of my injuries, I authorize the COLUMBUS POLICE DEPARTMENT to provide emergency medical assistance on site and call for necessary medical assistance in accordance with standard emergency medical protocols.

WAVIER, RELEASE and INDEMNITY: In consideration for being able to participate in the Event,Ihereby release and forever discharge and hold harmless Columbus, Georgia, including but not limited to its Columbus Police Department, its elected officials, officers, employees, board members, and agents and their successors and assigns (hereinafter “the Releasees”) from any and all liability and claims, demands, rights of action, or actions, of whatever kind of nature, either in law or equity, which arise or may hereafter arise from the Event. I understand and acknowledge that the execution of this Release discharges and will discharge the Releasees from any liability or claim that the undersigned may have against Releasees with respect to any bodily injuries, illnesses, death, or property damage which may result from the Event.I further understand that Releasees assume no responsibility for and are not obligated in any way to provide financial assistance or other assistance including but not limited to medical, health, or disability or liability insurance, in the event of injury, illness, or death, and all participants in the Covered Activities are expected to have their own liability and medical insurance which covers them during participation in the Event. I agree to hold harmless and indemnify Columbus from any legal matter, lawsuit, or litigation, arising from this relationship.

I, the Event participant named below, have read this paper, and fully understand the provisions of the release I am signing.I understand that by signing this paper, I am saying that I agree with the provisions of this release.

IF PARTICIPANT IS UNDER EIGHTEEN YEARS OF AGE. PLEASE COMPLETE THE FOLLOWING:

I, the person named below, am the legal parent or guardian of the above-named participant, with full authority to waive legal claims on his/her behalf. I hereby consent to his or her participation in the clinical program and voluntarily agree to all terms of this Release, Waiver, Assumption of Risk, and Indemnity Agreement and execute the same on his/her behalf.