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

 This form can be returned to Kaia Fit at 5330 Grass Valley Road, Unit B or

 Tutu’s Toppers at 1038 Grass Valley Road, Suite C

 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:

            1038 Grass Valley Road, Suite G or 26 Twyila Court

Winnemucca, NV 89445,

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: ________________________________________