Participant Acknowledgment, Assumption of Risk and Release

Participant Acknowledgment, Assumption of Risk and Release

March for Liberty on November 21, 2026
Please use a separate form for each participant in your party.
Name of Adult Participant

First NameLast Name
**If you are filling this out for a child under 18, Name of Minor Participating

First NameLast Name
I voluntarily choose to participate and knowingly assume the ordinary and inherent risks associated with the event. I affirm that I am physically able to participate safely and that I am responsible for determining whether participation is appropriate for me.

I release and hold harmless the County of Suffolk and the Manor of St. George, their property owners, sponsors, officers, employees, agents and volunteers (the “Released Parties”) from any and all claims for personal injury, illness, death, or property damage arising out of my participation in the event arising from the negligence of my voluntary participation and any such claim caused in whole or in part by the negligence of the Released Parties in the event, except to the extent of gross negligence or intentional misconduct that a claim may not lawfully be waived.

I agree to follow event rules and the reasonable instructions of event personnel and public-safety officials. I understand that I may be removed from the event for unsafe, unlawful or substantially disruptive conduct.

If emergency medical attention is reasonably considered necessary, I authorize event personnel to contact emergency services. I understand that I am responsible for any medical expenses incurred on my behalf.

I have read and understand this acknowledgment and sign it voluntarily.
Signature
IF YOU ARE SIGNING FOR A MINOR CHILD

I am the parent or legal guardian of the minor participant identified above. I give permission for the minor to participate in the March for Liberty, acknowledge the risks described above, and agree that the minor will follow all event rules and instructions.
Signature
Name of Parent or Guardian

First NameLast Name
Phone Number for the Parent or Guardian
Please enter a valid phone number.Format: (000) 000-0000.
Name of the Person Accompanying the Child on the Walk

First NameLast Name
Phone Number of the Other Adult
Please enter a valid phone number.Format: (000) 000-0000.
Name of and Additional Emergency Contact

First NameLast Name
Phone Number for the Emergency Contact
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty: