Registration form for:
4MILES
4
BECKY
October 28, 2006 Run/Jog /Walk
FULL NAME (print) _________________________________________________________
ADDRESS ________________________________________________________________
AGE _________________________________
PHONE ______________________________
SIGNATURE (in person) _________________________________________________
DONATION CHECK #_________________ AMOUNT _________________ CASH_________________
RUNNER'S NO. (given out Oct. 28) _____________________
Please print and drop this registration form at the Palm Lake Elementary School Main Office now through October 27. If you can't register within that time period, you can register in person the day of the event. The registration fee can either be cash or a check payable to:
Becky's
Bunch Support Trust
Waiver Must Be Read and Signed Before Submitting Registration:
I know that running/jogging/walking is a potentially hazardous activity. I should not enter or run/jog/walk in this activity unless I am medically able and properly trained. I assume all risks associated with running in this event including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release Becky’s Bunch, Palm Lake Elementary School, OCPS, A Mortgage Solution, U.S.A., Orange County Sheriff’s Department, plus all other sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the persons named in this waiver.
X_________________________________________________________________________
Signature / Date / Parent's signature if under 18 (must be signed in person)