PUMPed to Run Volunteer Sign-Up

Name*
First Last
Email*
Phone*
I consent to my phone and email being shared with my Lead Mentor:*
- Yes, I consent to my phone & email being shared with the Lead Mentor for planning purposes
I have read through the Mentor Guidebook and Quick Guide (links are below) before my first run/walk with PtR*
The PUMPed to Run Mentoring Quick Guide can be found here: https://www.pump.org/wp-content/uploads/2020/03/PtRMentorGuidebook_Quick-Notes.pdf The PUMPed to Run Mentoring Guidebook can be found here: https://www.pump.org/wp-content/uploads/2020/03/PtRMentorGuidebook.pdf
- Yes, I ensure that I will read through these on my own prior to my first walk/run
- Yes, and I would like to speak with someone on the phone before my first walk/run to go over any additional questions
I am interested in the following walks/runs:*
Definitions: Scheduled Mentor - You are committing to a weekly day/time for a set amount of time that is longer than 1 month. You can take off as needed, but we ask that you let you Lead Mentor know when you cannot make it. Substitute Mentor - This is someone who cannot regularly attend, but wants to be asked when more people are needed for a specific run/walk. We plan to add more walks/runs into our schedule so stay tuned.
- Scheduled Mentoring at 5:30 PM on Mondays from Wood Street Commons (Lead; TBD)
- Substitute Mentoring at 5:30 PM on Mondays from Wood Street Commons(Lead TBD)
- Scheduled Mentoring at 7:00 AM on Wednesdays from North Side Common Ministries (Lead Jaime)
- Substitute Mentoring at 7:00 AM on Wednesdays from North Side Common Ministries (Lead: Jaime)
- I cannot make any of these at this time, but would like to be contacted if other options become available
Participation Waiver*
I agree to the participation waiver: (Required)
Waiver of Liability, Release, Assumption of Risk and Indemnity Agreement

For and in consideration of my registration with the Pittsburgh Urban Magnet Project (“PUMP”) and being allowed to participate in any program, event or activity sponsored by PUMP, (including but not limited to: the Pittsburgh Sports League (“PSL”) competitions, service projects, Kickball for a Cause, Steel City World Cup, Yoga in the Park, self-defense training programs, fundraising events, and corporate sporting events and tournaments, and any other event, competition or program sponsored by PUMP, each of which is hereinafter known as a “Program” and known collectively as “Programs”), I hereby forever waive, release, discharge and relinquish for myself, and my heirs, administrators, successors and assigns, any and all claims, rights, actions, suits or causes of action against PUMP, PUMP’s sponsors, other Program participants, coaches, officials and owners of the various sites of Programs (hereinafter collectively referred to as “Releasees”) for personal injury, property damage, wrongful death or any other type of injury or damages arising out of my participation in Programs, and/or any activities incidental thereto, including transportation to and from PSL competitions, whenever or however they may occur or arise.

I fully understand and acknowledge that a Program may involve risks and dangers to my person including bodily injury, partial or total disability, paralysis, and death, and damages which may arise therefrom and I acknowledge and voluntarily assume all such risks and dangers in connection with my participation therein. I further understand and acknowledge that these risks and dangers may be caused by my own negligence or the negligence of others and I knowingly and voluntarily assume all such risks and dangers whether caused by my own negligence or the negligence of others. I further acknowledge that there may be risks and dangers that are not known to PUMP or myself or are not reasonably foreseeable at this time and I voluntarily assume all such risks.

I covenant and agree not to sue the Releasees, or any of them, for or on account of any injury or damages I may suffer in connection with my participation in a Program, and further agree that if any person or entity brings any claim or lawsuit for personal injury, property damage, wrongful death, subrogation or any other cause of action against Releasees related to any injury or damages I may suffer in connection with my participation in a Program, I shall defend, indemnify and hold harmless Releasees from any and all such claims or causes of action by whomever or wherever made or presented.

I represent and warrant that I am in good health, physically fit and in proper physical condition to participate in Programs, and that I have had the opportunity to seek the advice of my personal physician prior to participating therein. I further represent and warrant that I am at least eighteen (18) years old; provided, however, that if this registration is for participation in a Program at a licensed site where alcoholic beverages are served, I represent and warrant that I am at least twenty-one (21) years old.

I HAVE READ THIS WAIVER OF LIABILITY, RELEASE, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT AND UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE SIGNED THIS AGREEMENT FREELY AND WITHOUT PROMISE OR INDUCEMENT EXCEPT AS SET FORTH HEREIN. THE RELEASE, WAIVER, ASSUMPTION OF RISK AND INDEMNITY HEREIN ARE INTENDED TO BE AS BROAD AND INCLUSIVE AS PERMITTED BY LAW, AND TO BIND MYSELF AND MY ESTATE. IF ANY PORTION HEREOF IS HELD TO BE INVALID, I AGREE THAT THE BALANCE SHALL NOTWITHSTANDING CONTINUE IN FULL FORCE AND EFFECT. THIS AGREEMENT SHALL BE GOVERNED BY PENNSYLVANIA LAW, AND THE VENUE FOR ANY LITIGATION ARISING WITH RESPECT HERETO SHALL BE EXCLUSIVELY IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA.
COVID-19 Waiver and Hold Harmless Agreement*
I agree to the participation waiver: (Required)
In consideration of participating in PUMP Program(s), related event(s), or activity, I acknowledge and agree to the following:
I understand the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the
World Health Organization. I understand COVID-19 is highly contagious and is believed to spread mainly
from person-to-person contact. I understand that an individual can be infected with COVID-19 without
their knowledge and be asymptomatic.
I understand that the circumstances regarding COVID-19 change frequently and that CDC
Guidelines are frequently updated. I accept full responsibility for familiarizing myself with the most recent
update. PUMP has put in place preventative measures to reduce the spread of COVID-19, however I
acknowledge that PUMP cannot guarantee that I or anyone else will not become infected with COVID-19,
including my spouse, guests, unborn child, or relatives. I understand Participation in a PUMP athletic
sports program(s), related event or activity, could increase the risk of contracting COVID-19.
I acknowledge and fully assume the risk of illness or death related to COVID-19 arising from
participating in the sports program(s) and related activities and hereby RELEASE, WAIVE, DISCHARGE, AND
COVENANT NOT TO SUE (on behalf of myself and any minor children from whom I have the capacity
contract) PUMP or PUMP’s officers, directors, agents, employees and assigns (the “RELEASEES”) from any
liability related to COVID-19 which might occur as a result of my participating in the sports program(s) and
related activities.
I shall indemnify, defend and hold harmless the RELEASEES from and against any and all claims,
demands, suits, judgments, losses or expenses of any nature whatsoever (including, without limitation,
attorneys’ fees, costs and disbursements, whether of in-house or outside counsel and whether or not an
action is brought, on appeal or otherwise), arising from or out of, or relating to, directly or indirectly, the
infection of COVID-19 or any other illness or injury.
It is my express intent that this Waiver and Hold Harmless Agreement shall bind any assigns and
representatives, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE
the above-named RELEASEES. This Agreement and the provisions contained herein shall be construed,
interpreted and controlled according to the laws of the State of Pennsylvania. I HEREBY KNOWINGLY AND
VOLUNTARILY WAIVE ANY RIGHT TO A JURY TRIAL OFANY DISPUTE ARISING IN CONNECTION WITH THIS
AGREEMENT. I ACKNOWLEDGE THAT THIS WAIVER WAS EXPRESSLY NEGOTIATED AND IS A MATERIAL
INDUCEMENT THE PERMISSION GRANTED BY RELEASEES TO PARTICIAPTE IN THE ACTIVITIES.
Public Relations Waiver Form: (Optional)
I consent to the PtR Public Relations Media Form
The Pittsburgh Urban Magnet Project (PUMP) is a 501(c)(3) nonprofit organization. I give PUMPed to Run, a program of PUMP, and PUMP itself my consent and permission to use my photograph, story or video including me for media and educational purposes, website, social media and other promotional or informational materials for the purpose of informing others about PUMPed to Run. I understand that consenting to the use of my image may associate me with experiencing homelessness, or other treatment services, since PUMPed to Run is a running group largely composed of residents of homeless shelters and treatment facilities.
I hereby release Pittsburgh Urban Magnet Project (PUMP) from any and all claims, demands, actions, causes of action, suits, costs, expenses, liabilities, and damages whatsoever that I might hereafter claim against PUMP in connection with this photograph, story or video. I understand that I will not be compensated for this use.
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