G.V. (Sonny) Montgomery VAMC ASD

In consideration of participating in a STRIVE4You event , I, the undersigned, freely understand and acknowledge that my participation may involve physical contact which might result in serious injury or death.    I agree:

1. To comply with the terms and conditions for participation. If I encounter any hazard, whether from myself or from others, during my participation in the STRIVE4You event, I agree to withdraw from participation, alert a STRIVE4You representative of my withdrawal and remove myself from participation. 
2. To indemnify and hold STRIVE4You its Director, its Coaches and its partners , harmless from any and all injuries I may incur while participating.
3. To grant all right, title and interest in and to my name, image, voice or statement, including any and all photographic images, audio or video recordings captured during the STRIVE4You event.

I certify that I am in good physical health and have no disclosed or undisclosed conditions or injuries that would impact upon, impair or prevent my participation in the STRIVE4You event beyond reasonable accommodations.  

In the event I am injured during the course of the STRIVE4You event , I consent to being medically attended or treated by a physician, a nurse, athletic trainer, or other medical emergency personnel. 

STRIVE4You is a community-based organization dedicated to providing education, resources, and opportunities to people with disabilities and those that interact with them within the community. Participation in STRIVE4You’s programs is subject to the observance of the organization’s rules and procedures. The activities outlined below are strictly prohibited. Any participant or staff member who violates this Code is subject to discipline, up to and including immediate removal from the event or program.

• Abusive language towards a staff member, volunteer, or another participant.
• Possession or use of alcoholic beverages or illegal drugs while attending a STRIVE4You event. Or reporting to an event while under the influence of drugs or alcohol.
• Bringing onto the property of STRIVE4You or it’s partner’s property dangerous or unauthorized materials such as explosives, firearms, weapons, or other similar items.
• Discourtesy or rudeness to a fellow participant, staff member, or volunteer.
• Verbal, physical, or visual harassment of another participant, staff member, or volunteer.
• Actual or threatened violence toward any individual or group.
• Conduct endangering the life, safety, health, or well-being of others.
• Failure to follow any agency policy or procedure.
• Bullying or taking unfair advantage of any participant.

I have read and I understand STRIVE4You’s Participant Code of Conduct. I agree to abide by the rules described above and understand that I may be removed as a participant and face criminal prosecution if I violate any of these rules.

By typing your full name and the date in the edit box below you acknowledge that you have read and understand the waiver and the code of conduct. Please type your name and the date  in the text field below.