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Captain Request - Heart of a Lion 5K Run
September 15, 2019
Current Captain Application? *
I have filled out the Captain Application on the Michigan Chapter website at: https://www.myteamtriumph-mi.org/become-a-captain
Last Name *
First Name *
Street Address *
City *
State *
Zip *
Phone *
xxx-yyy-zzzz
Email *
Emergency Contact Name *
Emergency Contact Phone *
Birthdate *
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DD
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YYYY
Shirt Size *
mm/dd/yyyy
Teammate Request
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):
Event Waiver *
In consideration of you accepting this entry, I, the participant, intending to be legally bound and hereby waive or 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 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 also authorize the use of photographs or videos that include my image for promotional, informational, or other reasons deemed to be in the best interest of the event.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 my physical condition has been verified by a licensed Medical Doctor. 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 waiver.
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