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