In the "Hexagon", people who sign up for a race are required to supply a doctor's certificate confirming that they are at least physically fit enough to undertake a race of this kind. Those who run more regularly and are members of a club are automatically members of the French Athletics Federation, the FFA, and therefore just have to provide a photocopy of their "licence" to prove their aptitude for a race.
By contrast, in the US, where individual liberty is valued almost above anything else and where people are suspicious of any form of authority, race organisers do no require you to prove you won't have a heart attack and die while taking part in a sporting event. The general idea is that if you want to run a race, you shouldn't be prevented from doing so by some meddling medic. However, because America is also Tort Central, race organisers want to avoid being sued by litigious souls stupid enough to overexert themselves, but who have ready access to a lawyer keen to extract seven-figure compensation.
As a consequence, would-be participants in any race are made to sign extensive waivers designed to absolve organisers of any responsibility associated with racing. The following is an actual waiver that I signed and typical of the hand-washing that goes on:
"I realize that this course presents a number of potential dangers to me and I hereby assume the risk arising from all of them. I realize that I will be running on a variety of surfaces, some of them far less than perfect. The roads are open to motor vehicle traffic that has the right of way. I realize that the danger of injury and even death exists as well and I hereby assume all the risks that may be present on the course. I realize this race is a strenuous athletic event. I certify that I have no physical or medical condition which would interfere with my participation in the race and that I have trained adequately for this race. I realize that I have the sole and ultimate responsibility for my own safety during the race and that if I see a situation/condition which presents risk of injury to me, I will avoid the situation/condition or immediately withdraw from the race. I her e b y waive for myself, my heirs, executors and all other successors of interest any and all rights and claims which I may now have or hereafter accrue against the organizers and sponsors of this event, against all other entities and people who may issue permits for or help with this event, and against all property owners of land which the course may pass. I make this waiver for all the rights and claims that have been specific ally referred above, and for all others which might not be specifically named. I agree and intend that the above recitations are contractually binding and if I or my successors assert a claim in contravention of this agreement, I or my successors shall be liable for the expenses (including all legal fees) incurred by the other party in defending."






