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 & Release: In consideration for my entry being accepted, I hereby waive and release forever for myself, for my
heirs, executors, administrators, any & all claims of actions & suits I may accrue against the Porterville Breakfast Rotary, 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, property damage or economic loss, including death, suffered by me while traveling to and from or competing in the Porterville Cancer
5K run or 5K Walk on May 3, 2008 whether from natural hazards, human-made or any other defect or omission or act. |
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| Team Name:
_____________________________________________________ |
| Address:
_______________________________________________________________ |
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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.
|