Ninth Annual

 

 

Family And Team Release Form

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.

Thank you for registering for the Steps To Safety 5K. Team or Family Captains, please printout the following Release Form and have each of your participating team or family  members sign their agreement to the following. (Parent must sign if runner is under 18 years old)

FAMILY AND TEAM RELEASE FORM

*EACH participant must provide a signature to certify the following statement (Parent must sign if runner is under 18 years old): I understand that my participation in the Steps To Safety 5K walk/run is completely voluntary, and I release the Centre County Women’s Resource Center and its officers, directors, employees, and agents from any and all liability for injury to me which may result from my participation.

Team Name: _____________________________________________________
Address: _______________________________________________________________
City: ____________________________      State: ____________    Zip: ______________
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
Team Member #6: _________________________
PRINT NAME                                          
_________________________
RELEASE SIGNATURE
Team Member #7: _________________________
PRINT NAME                                          
_________________________
RELEASE SIGNATURE

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.

Additional Information: Online, at www.ccwrc.org