By registering as a member The Chicago Lighthouse for People Who Are Blind or Visually Impaired (The Chicago Lighthouse) team for the 2012 Bank of America Chicago Marathon, I understand that I am committed to raising a minimum amount for The Chicago Lighthouse.

Minimum amount and fundraising commitment: I understand I am required to raise $1,000 for The Chicago Lighthouse. This is in addition to the $150 marathon registration fee.

If for any reason I am unable to finish my training or the marathon, I recognize that I am still responsible for raising $1,000 for The Chicago Lighthouse. If I am unable to raise the required donation amount by October 1, 2012 at 12:00 AM CST, then I agree to pay the remainder due via credit card and agree to allow The Chicago Lighthouse to charge my credit card for the remaining amount due.

After I commit to joining Team Lighthouse, I will provide The Lighthouse with an operational credit card that will be valid on October 1, 2012. A member of the  Lighthouse staff will collect this information after receiving my online submission. All credit card information will be kept secure and confidential.

I also realize that I am committed to raising this money regardless of injury or unforeseen circumstances that may prohibit me from participating in the marathon.

I will notify The Chicago Lighthouse of any address, email, phone number, or any other changes so that my contact and participation information is current and accurate.

I am fully aware of and appreciate that training for and running a marathon may result in accidents or serious injury. I am voluntarily participating in The Chicago Lighthouse Bank of America Chicago Marathon Team with complete knowledge of the associated risks.

By signing this Waiver and Release, I declare that I am medically able, properly trained, physically fit, capable of participating in a marathon, and that my physician has approved my participation.  I agree to independently consult my physician regarding my participation in the marathon.  I also acknowledge full and sole responsibility for my own medical expenses and any and all injuries incurred as a result of participating in the marathon.

In consideration for being permitted to participate in The Chicago Lighthouse Bank of America Chicago Marathon Team, I agree to assume all risks and to release and hold harmless The Chicago Lighthouse, its Board of Directors, President and Executive Director, and its employees.  I understand and agree that this Waiver and Release is binding upon my heirs, assigns, and legal representatives.

I also herby grant my consent and permission to The Chicago Lighthouse and its employees the right to use any and all information submitted in my application, and my name, photograph, videotape, motion picture recording, voice or likeness for any purpose, including pre-race and post race publicity.

By signing this waiver, I have indicated that I have read, understand, and agree to The Chicago Lighthouse fundraising commitment and this Waiver and Release.

Yes, I accept the the terms of this agreement

or

No, I do not accept the terms of this agreement

The Chicago Lighthouse  |  1850 West Roosevelt Road  |  Chicago