WHERE: Curtiss Mansion, Miami Springs, FL

WHEN:   November 4, 2017

TIME:     7:00am-10:00am

 

**Please ONLY register ONE participant per submission, as we need EACH participant to agree to the waiver.

Event Information: You may ONLY select 1.

Quantity
Price
Total
5K Run/Walk Ticket

5K Run/Walk Ticket ONLY - You will receive a 2017 race t-shirt.

X
$
30.00=
$
0

5K Run/Walk & Fundraise

Includes 2017 race t-shirt. Fundraise over $250 and receive an embroidered SebastianStrong runner's cap. Fundraise over $500 and receive an embroidered Adidas long sleeve performance shirt. Fundraise over $1000 and receive both. Registration confirmation email will provide link to fundraising page and instructions.

X
$
30.00=
$
0

Fundraise ONLY

Includes 2017 race t-shirt. Fundraise over $250 and receive an embroidered SebastianStrong runner's cap. Fundraise over $500 to receive an embroidered Adidas long sleeve performance shirt. Fundraise over $1000 and receive both. Registration confirmation email will provide link to fundraising page and instructions.

X
$
30.00=
$
0

Volunteer

Volunteer & donate or fundraise over $30 to earn your 2017 5K t-shirt.

X
$
30.00=
$
0

Final Total:
$
0

**ONE WAIVER MUST BE CONSENTED TO FOR EACH PARTICIPANT**

 

PLEASE TAKE A MOMENT TO READ THE FOLLOWING WAIVER.  

CONSENT AND RELEASE FOR 1st ANNUAL SEBASTIANSTRONG CHILDHOOD CANCER AWARENESS 5K RUN/WALK 

In signing this release, I__________("Participant") will be participating in and attending the 1st Annual SebastianStrong Childhood Cancer Awaress 5K Run/Walk event for the purpose of fundraising and/or raising awareness of and for the SebastianStrong Foundation.  I acknowledge that I am physically fit and able to safely participate in the event without risk to myself or others.  I understand that there may be risks associated with participating in a physical activity and assume all risks of injury that may occur as a result of participating in the Event.  I, for myself, my heirs, executors and administrators, hereby agree to indemnify and hold harmless SebastianStrong Foundation, Inc., all public or private agencies whose property and/or personnel are used, all other sponsoring or co-sponsoring companies or individuals and all individual organizers or volunteers related to or involved in the Event (collectively "Releasees") from all liability to myself and my personal representatives, assigns, heirs, and executors, for all loss(es) or damage(s) and any and all claims or demands therefore, on account of injury to myseslf or property.  I assume the risks of loss(es), damage(s), or injury(ies) that may be sustained by myself while participating in the aforementioned activity.

 

I consent to SebastianStrong Foundation taking photos and/or videos of myself during the activity listed above.  I understand that I am consenting to us of said photos and videos in printed materials, social media, videos, and presentations without any compensation.

 

PARTICIPANT HAS READ THE FOREGOING AND INTENTIONALLY AND VOLUNTARILY ACCEPTS THIS RELEASE AND WAIVER OF LIABILITY AGREEMENT.

Contact Information

Date of Birth (xx/xx/xx)*
Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code

Share This Form

Powered by eTapestry.