Fillable Optimist international race packet Participant Registration Form

Fill Online, Printable, Fillable, Blank Optimist international race packet Participant Registration Form Form

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Optimist international race packet Participant Registration Form

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The Optimist international race packet Participant Registration Form form is 1 page long and contains:

  • 1 signature
  • 0 check-boxes
  • 17 other fields

Country of origin: US
File type: PDF

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7
Participant Registration Form
________________________________________________________________________________________
Walker’s Name
________________________________________________________________________________________
Address
________________________________________________________________________________________
City State/Province ZIP/Postal code
______________________________________________ ____________________________________
Phone E-mail
_____________________________________________ ____________________________________
Date of Birth Emergency Contact Person
________________________________________________________________________________________
Address
________________________________________________________________________________________
City State/Province ZIP/Postal code
______________________________________________ ____________________________________
Phone Relationship
________________________________________________________________________________________
Walking for or in memory of (if applicable)
___________________________________________________________________________
Waiver, Release and Indemnication of Liability:
In consideration of this entry, I the undersigned intended to be legally bound, hereby for myself, my
heirs, executors and administrators, waive and release any and all rights and claims for damages, actions
and causes of actions against the sponsoring Optimist Club, Optimist International and their afliates,
subsidiaries, ofcials, representatives, employers, successors, volunteers and assigns for any and all
injuries suffered by me in this event. I attest that I am physically capable to compete in this walk. I grant full
permission for the free use of my name and/or photographs or any record of this event for any legitimate
purpose.
________________________________________________________________________
Signature (if under 18 years of age, parent or guardian must sign)
____________________
Date
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Optimist international race packet Participant Registration Form

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Completed 29 January 2020

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