Request edit access
Angel Request-Race for Rare Kids on Lake Michigan 5K
September 7th, 2019
Email address *
Current Angel Application? *
I have filled out the Angel Application on the Michigan Chapter website at: https://www.myteamtriumph-mi.org/become-an-angel
Last Name *
Your answer
First Name *
Your answer
Phone *
xxx-yyy-zzzz
Your answer
Email *
Your answer
Pace *
This is a 5K run. Please provide your pace per mile for this distance. MyTeam Triumph makes an effort to team Angels with others of similar pace.
Your answer
Angel Team Members
If you would like to team with specific Angels for this event, please share their names here (while we cannot guarantee teaming arrangements, we will do our best to honor your request):
Your answer
Captain Team Member
If you would like to team with a specific Captain for this event, please share his or her name here (while we cannot guarantee teaming arrangements, we will do our best to honor your request):
Your answer
Event Waiver *
In consideration of you accepting this entry, I, the participant, intending to be legally bound do hereby waive and forever release any and all right and claims for damages or injuries that I may have against the Event Director, RunSignup.com, and all of their agents assisting with the event, sponsors and their representatives, volunteers and employees for any and all injuries to me or my personal property. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees.I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able to do so and properly trained. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of weather, traffic, and course conditions, and waive any and all claims which I might have based on any of those and other risks typical found in running a road race. I acknowledge all such risks are known and understood by me. I agree to abide by all decisions of any race official relative to my ability to safely complete the run. I certify as a material condition to my being permitted to enter this race that I am physically fit and sufficiently trained for the completion of this event and that a licensed Medical Doctor has verified my physical condition.In the event of an illness, injury or medical emergency arising during the event I hereby authorize and give my consent to the Event Director to secure from any accredited hospital, clinic and/ or physician any treatment deemed necessary for my immediate care. I agree that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to medical transport, medications, treatment and hospitalization.By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to the above release and waiver.Further, I grant permission to all the foregoing to use my name, voice and images of myself in any photographs, motion pictures, results, publications or any other print, videographic or electronic recording of this event for legitimate purposes.
Required
Event Registration Fee *
As a charity organization, myTEAM TRIUMPH relies on donations from Angels, family, friends, employers, etc. Your donation here, directed to myTEAM TRIUMPH, will cover the typical registration fee you pay on an event's signup website, whether it be for this event, or another if this event is comped. Any additional donation amount here will support our mission of enabling individuals with disabilities to participate in endurance athletics. MyTEAM TRIUMPH will cover total event registration requirements for our participant list via one lump sum payment. The minimum event registration fee will typically preclude any packet materials provided by event sponsors, including event shirt.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of myTEAM TRIUMPH. Report Abuse