In the sections below, you can customize your team page. You can add your story, a picture and the fundraising goal of your team. Changes can be made to your page at any time by emailing us at info@epilepsyct.com. You will also receive a link to your team page by email so you can easily share it with your family, friends and co-workers.
Upload Team Picture
Payment Information
Please review your information carefully. Once you submit your registration your information you will no be able to make any changes.
Total: $
Waiver and release of liability and assumption of risk and indemnity agreement
In consideration of being permitted to participate in the Walk to End Epilepsy in Connecticut (the "Event") as a walker, runner, cyclist or volunteer, or in any other capacity, I, for myself, my heirs, next of kin, assigns and personal representatives: Represent that I am qualified, in good health and in proper physical condition to participate in the Event and that I will stop my participation if I believe this Event becomes unsafe. Acknowledge and understand fully that there are risks and dangers of serious bodily injury and death that could result from my participation in the Event from any cause. Being aware of these risks and dangers, I have voluntarily elected to participate in the Event and I FULLY ACCEPT AND ASSUME ALL RISKS AND ALL RESPONSIBILITY FOR ANY INJURY, LOSSES AND DAMAGES TO PERSON OR PROPERTY THAT I INCUR AS A RESULT OF MY PARTICIPATION IN THE EVENT. I HERBY AGREE NOT TO SUE AND TO RELEASE, DISCHARGE, WAIVE, HOLD HARMLESS AND TO INDEMNIFY THE EPILEPSY FOUNDATION OF CONNECTICUT and their respective officers, directors, employees, volunteers, sponsors, advertisers, participants, agents and representatives FROM AND AGAINST ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, LOSSES, DAMAGES, SUITS AND PROCEEDINGS, REGARDLESS OF THE CAUSE. I agree to permit the use of my name and/or likeness in any record or communication relating to the Event for any legitimate purpose, without compensation or remuneration.Helmets are required for cyclists.
By checking below, I confirm that I have read this agreement and understand that I have given up substantial rights by agreeing to it.
