Address:

                          City:

                        State:

                            Zip:

                       Phone:

                     E-Mail:

                           Age:

         Age Category: Select One 12 and under with shirt 13 and over with shirt 12 and under no shirt

                   Gender:   Select One Female Male

             T-Shirt Size:   Select One Small Medium Large Extra Large Under 12 no shirt

Where did you hear about event:

Waiver of Participation

ADULT AUTHORIZATION FOR EMERGENCY & ROUTINE MEDICAL TREATMENT AND RELEASE OF LIABILITY

I, give my permission to City of Lansing, it’s volunteers, employees, and representatives, to obtain or provide such emergency or routine medical treatment for me as they, in the exercise of their discretion, deem necessary or appropriate while I participate in any activity offered by City of Lansing. Further, in consideration of city of Lansing making this available to me, I, for myself, and anyone claiming under or through me, hereby release and discharge city of Lansing, its employees, representatives and volunteers from all liability, claims, demands, and actions, regardless of kind of character, connected with, arising out of, or in any way participation in such activity.

ADULT CONSENT TO PHOTOGRAPH/VIDEOTAPE & DISSEMINATE WITHOUT COMPENSATION I, hereby consent to being photographed/videotaped while participating in any activity offered by City of Lansing. In addition, I consent to the reproduction and use of any such photographs and videotapes by City of Lansing for educational, public relations and promotional purposes and I waive any claim by myself, or anyone claiming under or through me, for compensation of any kind in exchange for photographs, videotapes and use.

          Agree To Waiver:   Select Yes

    Participant Signature:  

    Signature above must be signed by parent or guardian if under 18

 

Online Registration Is Now Closed