I heard about Spaulding's Race for Rehab team from: *
If being referred by a staff member, alumni or former patient, please include his/her name.
I would like to run for Spaulding because: *
Describe your personal connection to Spaulding and/or rehab medicine. Please be specific in your response.
My other charity participation and fundraising experience includes: *
Please list events/races/rides participated in, total amount raised and the year.
Please read the following rules and requirements carefully before electronically signing below:
I, the "Participant," wish to participate in the 2023 Boston Marathon, being held on Monday, April 17, 2023, as a member of Spaulding Rehabilitation Hospital’s Race for Rehab Team.
If I am accepted, I agree to raise and/or contribute a minimum of $7,500 to Spaulding and will be personally responsible for the difference if I fail to collect the required funds by April 21, 2023. To secure my spot on the 2023 Race for Rehab Team, I will set up my personal fundraising page at the direction of team management and will provide a valid credit card with an expiration date of after June 2023. Spaulding Rehabilitation Hospital reserves the right to charge my credit card to achieve all fundraising deadlines. I also understand that Spaulding has the authority to rescind my entrance to the 2023 Boston Marathon at the discretion of team management for misconduct and/or inadequate fundraising.
I understand that I may cancel my participation with Spaulding's Race for Rehab Team prior to January 20, 2023 by contacting Reesa Morabito, Manager, Stewardship Events at firstname.lastname@example.org or 617-952-6881. Funds raised will not be returned or refunded under any circumstance. I understand and agree that injury, illness, travel complications and force majeure prohibiting my participation in — or completion of — the 2023 Boston Marathon after January 20, 2023, does not exempt me from the fundraising requirement and I will be responsible for all fundraising commitments.
In addition to the fundraising requirement, I am responsible for covering the
race registration fees, to be paid directly to the Boston Athletic Association and acknowledge that this does not count towards my fundraising goal. Entries are non-transferrable and cannot be deferred to a future year under any circumstance. By signing below, I also agree to all terms and conditions of the Boston Marathon set forth by the Boston Athletic Association.
In consideration of my accepting this entry, I hereby for myself, my heirs, executors and administrators, waive and release any and all rights for claims and damages I may have against Spaulding, its employees, volunteers, officers and sponsors for any and all injuries suffered or sustained by me in said event, in the training and planning sessions for said event, or from any of the preceding. I further attest and certify that I am physically fit — verified by a licensed medical doctor — and will sufficiently train for competition in the event.
I also grant permission for use of my name, photograph or voice in broadcast, telecast, print or any other account of this event — indefinitely — and agree to waive any compensation for such use. I declare that I have exercised my own judgment in signing this agreement and I further declare that the decision to sign this agreement was voluntary and not based on — or influenced by — any representation of Spaulding.
In the event of an illness, injury or medical emergency during the 2023 Boston Marathon — or in the training and planning sessions — I hereby authorize and give my consent to Spaulding to secure from any accredited hospital, clinic and/or physician any treatments deemed necessary for my immediate care. I agree that I will be fully responsible for payment of any and all medical services and treatments rendered to me including but not limited to medical transport, medication, treatment, and hospitalization.