Building the House of God 5K
August 9th, 2017 at Indianfields Park, Caro, MI
Are you registering an individual or a family?
First Name
Your answer
Last Name
Your answer
Age on August 9, 2017
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Home Phone
Your answer
Alternate Phone
Your answer
E-mail address
Your answer
Additional Family Members
Your answer
I have full knowledge of the risks involved and am physically fit to participate in this event. Also, in consideration of my participation in this event, I release and discharge St. Paul Lutheran Church, Caro and other participating organizations, including sponsors, for injuries or damages incurred during the event. I also authorize St. Paul Lutheran Church to utilize any photographs and/or video recordings of my participation in any St. Paul Lutheran Church event for any and all purposes, and to communicate with me about future events/promotions. I hereby give my permission for any above minor to participate in above activity. I hereby further give my permission for any above minor be given any necessary X-ray, examination, anesthetic, medical, or surgical treatment under the supervision of any physician or surgeon licensed under the Medical Practice Act. This authorization is given pursuant to the provisions of Section 2 of Act 116 of Public Acts 1973 (MCL) and after a reasonable attempt has been made to contact parents or guardians,
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms