Print out and bring the signed waiver to
pre-registration or to the race. You must have
the form completed and turned in prior to event start.
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Thank you for registering for the PORTERVILLE CANCER 5K
RUN/Walk.
Team Captains, please printout the following Release Form and
have each of your participating team members sign their
agreement to the following. (Parent must sign if
runner is under 18 years old) |
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Team
Wavier And Release
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*EACH participant must provide a signature to
certify the following statement (Parent must sign if runner is under 18
years old): Full Waiver and Release: In consideration for my
entry being accepted, I hereby waive and release forever for myself and
for my heirs, executors, administrators, any and all claims, causes of
actions and suits I may accrue against the Porterville Breakfast Rotary
Club, City of Porterville, County of Tulare, property owners on whose
property the race is run, race director, volunteers and any sponsors of
this race for any bodily injury, emotional injury, property damage or
economic loss, including death suffered by me while traveling to and
from or competing in the Porterville Cancer 5K Run and/or 5K or Short
Walk, on May 2, 2009 whether from natural hazards, human-made hazards or
any other defect or omission or act.
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| Team Name:
_____________________________________________________ |
| Address:
_______________________________________________________________ |
|
City: ____________________________
State: ____________ Zip:
______________
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| Team Captain
Phone:___________________ Team Captain Email: ___________________ |
| Team
Member #1: |
_________________________
PRINT NAME
|
_________________________
RELEASE SIGNATURE |
| Team Member #2: |
_________________________
PRINT NAME
|
_________________________
RELEASE SIGNATURE |
| Team Member #3: |
_________________________
PRINT NAME
|
_________________________
RELEASE SIGNATURE |
| Team Member #4: |
_________________________
PRINT NAME
|
_________________________
RELEASE SIGNATURE |
| Team Member #5: |
_________________________
PRINT NAME
|
_________________________
RELEASE SIGNATURE |
Print out and bring the signed waiver to pre-registration or to the
event. You must have the form completed and turned in prior to
event start.
|