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Hit The Bricks - ZCS Student & Family Discount Registration
October 5th, 2019 - Saturday
Event Address: ZCHS
Contact us at zoptimistclub@gmail.com
Individual or Family Registration Payment - please pay electronically via Venmo (to zoptimistclub@gmail.com) or via check mailed to ZOC, POBox 157, Zionsville, IN 46077 *
Required
Email *
Your answer
Name of adult completing form *
Your answer
Waiver: In consideration for my being permitted to participate in the Zionsville 5-K Run & Fun Run/Walk on October 5, 2019, I hereby release, discharge, and agree to hold free and harmless all sponsors, the Zionsville Optimist Club, the city of Zionsville, the State of Indiana, and their officers, agents, and representatives, from all liability for injuries to person, property or reputation suffered or claimed to have been suffered by me as a result of my participation in the Zionsville 5-K Run & Run/Walk. By signing this form, I verify that I am physically fit and have sufficiently trained for the competition of this race. I further agree to grant full permission to any and all of the foregoing entities, which this release is given, to use my likeness in any publication for legitimate purposes without payment or compensation. This release shall by binding upon my heirs, executors and administrators. The undersigned hereby grants Zionsville Optimist Club the permanent right to use any and all photography or footage taken of me in any of its promotional presentations, advertising, and publicity or in magazines, newspapers, catalogs or brochures or websites. I hereby release Zionsville Optimist Club and its administration from any and all claims that I might otherwise have in connection with such uses of my photographed image.I have read the above before signing. *
Required
#1 Participant Name *
Your answer
Address *
Your answer
Age of participant #1 on race day: *
Your answer
Sex of participant #1 *
#1 Participant - in which event do you plan to participate? *
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