WAM 2018 Registration

Quantity
Price
Total
Walk A Mile In Her Shoes Registration

You MAY register more than ONE individual.

X
$
30.00=
$
0
Participant Name: for multiple registrants, please skip and go to the MULTIPLE REGISTRATION box below.
T-Shirt Size
  • Small
  • Medium
  • Large
  • XL
  • XXL
  • XXXL
Shoe Size (Male Participants Only)
MULITPLE REGISTRATIONS: Enter their NAME, T-SHIRT SIZE, & SHOE SIZE (for men only)

Please use the additional comments box at the very bottom of the page for any questions/comments or concerns. Thank you! 

I HEREBY UNDERSTAND AND ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THE LAUREL HOUSE WALK A MILE IN HER SHOES EVENT (the “Event”).  In consideration of permitting me to participate in the Event, I hereby, for myself and for each of my executors, administrators, heirs, next of kin, successors, and assigns WAIVE, RELEASE, HOLD HARMLESS, PROMISE NOT TO SUE, AND DISCHARGE the Released Persons (as defined below) from any and all liability, including, but not limited to liability arising, directly or indirectly, from the negligence or fault of any of the Released Persons, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me in connection with the Event. “Released Persons” shall include The Laurel House; Pfizer; any sponsor of the Event, any volunteer assisting with the Event and/or any director, officer, employee,  representative or  agent of any of the foregoing entities or persons.

 

I certify that I have not been advised to not participate by a qualified medical professional.  I certify that there are no health-related reasons or problems which preclude my participation in the Event.

 

I understand while participating in this activity, I may be photographed.  I hereby irrevocably provide my consent and agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the Laurel House, Pfizer and any producers, sponsors, organizers of the Event and the successors or assigns of any of the foregoing entities.

 

The waiver and release and other agreements I have made herein shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
  • Yes
  • No

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