Superhero 5K Walk/Run Registration Form
Be a Super Hero- Help Stop
Child Abuse and Neglect! 5K September 29, 2018
Participant Contact Information
(please use separate sheet, if needed)
Name
_____________________________________________________________
Email
______________________________________________________________
Phone number
_____________________________________________________
Age _____________
Name
______________________________________________________________
Age _____________
Name
______________________________________________________________
Age _____________
Name
_______________________________________________________________
Age _____________
Registration information
Adults and youths 13 years+ $20
Families 4-6 participants ages 13+ $50
Tutu’s Toppers at 1038
Grass Valley Road
Payments
can be cash, credit card, or check made out to Advocates for Victims of Abuse
or
Humboldt AVA Check or cashiers check can be mailed to (please do NOT
send cash in the mail:
Or pay online via PayPal at: www.humboldtava.com
Please contact: Angie 702-343-2943 or
Chelle 775-722-4546 with any inquiries.
WAIVER OF LIABILITY: I know that participating in the
Advocates for Victims of Abuse’s SuperHero 5K Run/Walk is a potentially
hazardous activity. I agree not to enter and participate unless I am medically
able and properly trained. I agree to abide by any decision of an Event
official relative to my ability to safely complete the Event. I am voluntarily
entering and assume all risks associated with participating in the Event,
including, but not limited to, falls, contact with other participants,
spectators or others, vehicular or other traffic, the effect of the weather,
including heat and/or humidity, wind, cold temperature, wet or icy surfaces,
falling tree branches or other overhead objects, traffic and other conditions
of the course, all such risks being known and appreciated by me. Having read
this Waiver and knowing these facts, and in consideration of your acceptance of
this application, I, for myself and anyone entitled to act on my behalf, waive
and release the Released Parties (defined below), from present and future
claims and liabilities of any kind, known or unknown, arising out of my travel to or from or my participation in the event or related
actives, including personal injury or death, or property or economic damage,
whether caused in whole or in part by the
Released Parties or any other person or thing at the Event and even though such
claim or liability may arise out of negligence or fault on the part of any of
the Released Parties.
PUBLICITY RELEASE: I grant permission to each of the
Released Parties to use or authorize others to use any photographs, motion
pictures, recordings, or any other record of my participation in the Event or
related activities, including my name, for any legitimate purpose without
remuneration.
RELEASED PARTIES: This Waiver and Release is given to
Advocates for Victims of Abuse all sponsors and officials of the event, and the
officers, directors, employees, contractors, volunteers, agents,
representatives, and successors of the foregoing.
GUARDIAN’S PERMISSION AND RELEASE FOR
MINOR: If I am signing
this Waiver and Release on behalf of a minor, I understand and agree that my
child’s participation in this Event is by my choice and, I agree that the
Wavier and Release above applies equally to my child and me and any claims I,
he or she may have. I also waive any derivative claims that relate to or arise
out of my child’s participation in the Event. I also agree that the Publicity
Release above applies to my child and me.
RULES OF THE EVENT: I agree that attendance and/or
participation in the Event is subject at all times to any and all rules and
regulations of the Event. All entries are non-refundable.
Please note that there is no rain date for
the SuperHero 5k, and no refunds or cancellations for any reason.
Signature:
___________________________________________________
(Parent Signature required if participant
is a minor)
Date:
________________________________________
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