Registration Form
 

If you have questions please e-mail Alysha Rashid at Darfurwalk07@yahoo.com.

 
Name:
Date:
Age:
Address:
Phone:
Group Affiliation (Optional, if member of group):
Payment amount (Bring to check-in on walk day)
Waiver: I know that entering a road race is a potentially hazardous activity. I will not enter and participate unless I am medically able and properly trained. I assume all risks from participating in this event and its related activities, including, but not limited to, falls, contact with other participants, effects of the weather (including high heat and humidity), traffic and the other conditions of the road; all such risks being known and appreciated by me. Having read this waiver and release and knowing these facts and in consideration of your accepting my entry fee and participation, I, for myself, my heirs, executors, administrators and anyone entitled to act on my behalf, waive and release Peer Leadership, Save The Children, the city of Danbury, the Towns of Bethel and Brookfield, and the owners, operators and residents thereof, race officials, volunteers, all event sponsors and all others (including the respective affiliates, subsidiaries, principals, directors, agents, officers, employees and contractors of any of the foregoing) of and from all claims, damages, liabilities or cause of action of any kind arising out of my participation in this event or its related activities which I or my successors, assigns or heirs may ever have now or in the future against any of them. I grant permission to all the foregoing to use any photography, motion pictures, recordings or any other record of this event for any lawful purpose including the use of my name, my picture, and/or my voice. I know that dogs, bicycles, in-line skates and baby joggers are not allowed on the course.
Read the waiver carefully. Do you agree to Waiver? Yes, I agree
No, I disagree
Athlete's Name
Date:
Under 18 years of age? No
Yes, I have parent/Guardian approval
If under 18, Parent or Guardian Name approving participation:

(On next page wait until Continue appears and click it)


free web form
 
 
Thank you for your participation! With your help we can make this a successful event!