Team In Training: Climb 2 Cure Registration

Gender: *
Climb Selection: *
Fundraising Commitment Level: *
If available in your area, would you like to be connected to a local Team In Training training group? Please note not all locations have local training groups. *
I understand that I must contact Embark Exploration Company, the Climb 2 Cure trek partner, and pay a $500 deposit that will reserve my spot on the 2019 Cotopaxi trek. Embark Exploration Contact Info: carrie@embarkexplorationco.com or 503-922-1050 *
** Each teammate is eligible to earn a $1,000 transportation reimbursement for every $6,000 raised up to $5,000 for $30,000 raised.

Apparel Order

We'll mail you a Team In Training performance T-shirt to wear when you're training. 

Please refer to the training shirt size chart before choosing a size below.

After you complete your reservation for Climb 2 Cure with Embark, we'll also mail you a Climb 2 Cure event day shirt.

Please refer to the Climb 2 Cure shirt size chart before choosing a size below. Note that these shirts run large, and are unisex. For women's sizes, we recommend selecting one size smaller than you usually wear.

Emergency Contact

This person will be your emergency contact for training sessions. Please select your contact carefully and choose someone we will be able to reach easily during the training season. A secondary contact is not required but you may enter one in the space provided


Terms & Conditions

WAIVER & RELEASE AGREEMENT
Assumption of Risk and Complete Release of Liability

I, intending to be legally bound, understand and agree that I am voluntarily participating in a race, relay, endurance event, training program, sailing, boating, or other on-water activity, or other event(s) and all related activities (the “Event”) with The Leukemia & Lymphoma Society (“LLS”) at my own risk.

 

Assumption of Risk: I acknowledge that I am aware of the risks, both known and unknown, inherent in participating in the Event, including but not limited to: trips or falls; contact or collisions with other participants, spectators, or others; uneven surfaces; the effects of and exposure to weather and environmental conditions; and other training or Event course conditions; and that I HEREBY ASSUME SUCH RISKS and accept full responsibility for these activities, and for any injury, damage, death, or other loss suffered by me resulting from the Event and/or resulting from my own negligence or misconduct. I certify that I am physically fit, have not been otherwise informed by any physician, and know of no restrictions imposed on me that would prevent me in any way from actively participating in the Event.

 

Release and Indemnity Agreement:  In consideration of being permitted to participate in this Event, I, on behalf of myself, my successors in interest, heirs, assigns, and representatives, hereby waive all rights of subrogation and fully release, waive, discharge, indemnify, and hold harmless LLS and its subsidiary and affiliated organizations, its officers, directors, agents, employees and representatives, successors and assigns (be they individuals or organizations, singly and collectively), together with their insurers (“Releasees”), from any and all claims, liabilities, demands, suits or causes of action, which are in any way connected with my participation in the Event, including for any injury, damage, death, or other  loss. THIS RELEASE OF LIABILITY IS EFFECTIVE AND VALID REGARDLESS OF WHETHER THE INJURY, DEATH, DAMAGE, OR OTHER LOSS IS A RESULT OF ANY NEGLIGENT ACT OR OMISSION ON THE PART OF RELEASEES.

 

Medical Authorization: I hereby grant permission to the Releasees to render preventative or first-aid assistance or seek medical care that they deem reasonably necessary for my health and well-being, including transportation to a hospital or other medical facility. I agree to assume all risks and pay all costs associated with that assistance, care, and transportation.  

 

Code of Conduct: I agree to comply with all rules, regulations, and safety procedures during my participation in the Event and realize that my failure to do so may result in further injury and damage to myself or others for which I will be liable.    

 

Publicity Release:  In connection with my participation in the Event, I give permission for Releasees to use my name, photograph, likeness, and voice in any manner and in all media now or hereafter known, in perpetuity throughout the world, without compensation of any kind.

 

This Waiver & Release Agreement will be governed by and subject to the laws of the State of New York without regard to any conflict of law rules. Jurisdiction and venue in any matter arising out of this Waiver & Release Agreement shall be proper in the federal and state courts located in Westchester County, New York.

I HAVE READ AND FULLY UNDERSTAND THIS WAIVER & RELEASE AGREEMENT AND UNDERSTAND THAT I AM ASSUMING ALL THE RISKS INHERENT IN THE EVENT AND THAT I AM RELEASING ANY AND ALL CLAIMS THAT I MAY HAVE AS A RESULT OF MY PARTICIPATION IN THE EVENT. I agree that electronic submission of this waiver constitutes signature, and in doing so, I acknowledge and represent that I have read and understand this release and agree to it voluntarily. *

CLIMB 2 CURE CANCER - EXPRESS ASSUMPTION OF RISK, RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

MUST BE 18 OR OLDER TO PARTICIPATE IN THIS EVENT

Express Assumption of Risk Associated with Hiking/Trekking

I, intending to be legally bound, understand and agree that I am voluntarily participating in the Climb 2 Cure Cancer Event (“Event”) at my own request and at my own risk. I certify that I am physically fit, have not been otherwise informed by any physician and know of no restrictions imposed on me by my own physician that would in any way prevent me from actively participating in the Event. I acknowledge and affirm that I have been fully informed of the hazards and risks inherent in hiking/trekking activities.  

Inherent hazards and risks include (a), but are not limited to: 

  1. Risk of injury from the activity including the potential for permanent disability and death.
  2. My own negligence and/or the negligence of other third parties
  3. Broken bones, severe injuries to the head, neck, and back which may result in severe physical impairment or even death.
  4. Cold weather and heat related injuries and illness including but not limited to acute mountain sickness, frost bite, heat exhaustion, heat stroke, sunburn, hypothermia and dehydration.
  5. Exposure to outdoor elements, including but not limited to rock fall, inclement weather, lightning, high winds, temperature fluctuation or other weather conditions.
  6. Attack by or encounter with insects, reptiles, and/or animals.
  7. Accidents or illness occurring in remote places where there are no available medical facilities.
  8. Fatigue, chill, headache and/or dizziness, which may diminish my or others reaction time and increase the risk of accident.
  9. My sense of balance, physical coordination, and ability to follow instructions.
  1. I understand the description of these risks is not complete and that unknown or unanticipated risks may result in injury, illness or death.

Release of Liability, Waiver of Claims and Indemnity Agreement

In consideration for being permitted to participate in any way in Climb 2 Cure Cancer hiking/trekking related activities including and not limited to training, I hereby agree, acknowledge and understand that:

I HEREBY RELEASE AND HOLD HARMLESS THE LEUKEMIA & LYMPHOMA SOCIETY, INC. (“LLS”) WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE.

In consideration of being permitted to participate in this Event, I, on behalf of myself, my successors in interest, heirs, assigns, and representatives, hereby waive all rights of subrogation and fully release and agree to hold harmless The Leukemia & Lymphoma Society, Inc. and its affiliates, directors, officers, trustees, agents, employees and representatives, successors and entities (be they individuals or organizations, singly and collectively) (LLS), together with their insurers, and  their associated entities and their agents of and from, any and all liability, claims, damages or causes of action for any reason resulting from, and including, without limiting the generality of the following, death, bodily injury, property damage, disease, civil unrest, kidnapping, criminal or terrorist activities of any kind or any other loss or inconvenience whatsoever, suffered by me at any time hereafter occurring as a result of my voluntary participation in the Event.

By executing this document, I agree to hold LLS harmless and indemnify them in conjunction with any injury, disability, death, or loss or damage to person or property that may occur as a result of engaging in the above activities. By entering into this Agreement, I am not relying on any oral or written representation or statements made by LLS, other than what is set forth in this Agreement. This release shall be binding to the fullest extent permitted by law.  If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable.

Consent and Information Release (“Consent”): I hereby grant permission to LLS to render preventative or first-aid assistance or seek treatment or medical care that it seems reasonably necessary, including hospitalization, for my health and well being. I also give permission to LLS to use and disclose my personal health information (“PHI”) in the ways described in this form. I allow LLS to give out my PHI to doctors, hospitals, ambulance companies, coaches, family members, and others involved in my care and treatment. My PHI may also be used and given out as necessary to run the Event or as necessary for the proper management and administration of LLS. The LLS affirms that PHI will not be used for purposes unrelated to the participant’s health care. LLS will employ all reasonable measures to safeguard and maintain the confidentiality of PHI in its possession. This Release and Consent will be governed by and subject to the laws (except the choice of law principles) and exclusive jurisdiction of the courts of the State of New York.

By signing below, I allow physicians, hospitals, ambulance companies, or any other health care provider (“Providers”) to give out any and all medical information concerning the Participant. The Providers can give the information to coaches, staff, and volunteers working for or with LLS. This information includes oral or written medical information that related to or affects participation in activities, programs or events affiliated with or sponsored by LLS (“LLS Programs”). This information will be used in connection with LLS Programs. This information may include, but is not limited to, all information within a Provider’s knowledge. It includes information found in any records under his or her control or supervision concerning the Participant’s physical condition, illness, and/or injuries. This information may be used or given out by LLS as necessary to run the programs. This includes, but is not limited to, uses and disclosures to the Participant’s friends or family, coaches, LLS’s insurers, or other persons or entities involved in the LLS Programs.

I also give permission for the free use of my name, picture and voice in any broadcast, telecast, print account or any other account in any medium of this Event without limitation, now and in perpetuity throughout the world, without restriction as to alteration and acknowledge and agree to the release without compensation of any kind.

I agree that I am responsible for arranging my own travel/medical insurance for the full duration of the entire trip and should include coverage for medical expenses, injury, death and repatriation including but not limited to:

  • $50,000 emergency medical evacuation, including repatriation
  • $50,000 medical expenses
  • VERY IMPORTANT => the travel/medical policy must specifically cover hiking/trekking at high elevation and have no exclusions
  • I will provide evidence of travel/medical coverage to LLS at least three weeks prior to the start of the trip

LLS makes no specific recommendation of where to obtain coverage, but the policy should cover all of the above.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND I FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SIGNIFICANT LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT OR COMPENSATION and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

Electronic Signature Consent: I further agree that my electronic signature or acknowledgment constitutes my acceptance of this Waiver & Release Agreement and will have the same legal effect as an original signature.

I HAVE READ AND FULLY UNDERSTAND THIS WAIVER & RELEASE AGREEMENT AND UNDERSTAND THAT I AM ASSUMING ALL THE RISKS INHERENT IN THE EVENT AND THAT I AM RELEASING ANY AND ALL CLAIMS THAT I MAY HAVE AS A RESULT OF MY PARTICIPATION IN THE EVENT. I agree that electronic submission of this waiver constitutes signature, and in doing so, I acknowledge and represent that I have read and understand this release and agree to it voluntarily. *