Heather's Home 5K Volunteer Sign-up [ages 13-17]
THIS FORM MUST BE COMPLETED BY THE LEGAL GUARDIAN OF THE CHILD WHO IS VOLUNTEERING.
Event: Saturday, August 7, 2021 - SET-UP STARTS AT 7:00 A.M. NOTE: MANDATORY MEETING THURSDAY BEFORE RACE DAY AT 6:30PM.
Email *
I understand that my child must also attend the Volunteer Info Meeting on Thursday, August 5, at 6:30pm at Eldridge Park in order to volunteer. *
Areas my child would like to help out. We can't promise they will be assigned there, but it helps to know what they like to do. [check all that apply] *
Required
Although it is not required, would you or your child be able to help offset the cost of the Volunteer t-shirt? [Check all that apply] *
Required
Volunteer's First Name *
Volunteer's Last Name *
Volunteer's Telephone (xxx) xxx-xxxx *
Volunteer's T-shirt size *
Volunteer's Street Address *
Volunteer's City *
Volunteer's State *
Volunteer's ZIP *
Volunteer's Emergency Contact First Name and Last Name *
Volunteer's Emergency Contact Telephone Number (xxx) xxx-xxxx *
Emergency Contact Relationship to Volunteer *
Volunteer's Legal Guardian First and Last Name *
EVENT DISCLAIMER -- 13-17 YEARS OLD: By clicking YES, this becomes your electronic signature that you accept this Waiver and Disclaimer as the Legal Guardian of the Volunteer. By participating in this event, I do so at my own risk. I assume all risk of injury, illness, damage or loss to me or my property that might result in, including without limitation, any loss or theft of personal property. I consent to medical treatment for myself in the event of injury, accident and/or illness during the event. I agree on behalf of myself and my personal representatives, heirs, executors, administrators, agents, and assigns, to release and discharge the organizers of this event, its principals, its officers and directors, its employees, all sponsors and their representatives and employees, the City of Elmira and its officers and employees from any and all claims or causes of action (known or unknown) arising out of their negligence. I acknowledge that I have carefully read this ‘Waiver and Release’ and fully understand that it is a release of liability. By my selecting YES below for my electronic signature, I am waiving any right that I may have to bring legal action to assert a claim against any and all discharge the organizers of this event, its principals, its officers and directors, its employees, all sponsors and their representatives and employees, the City of Elmira and its officers and employees for their negligence. I hereby grant full permission to any and all of the foregoing to use my name and likeness in any broadcast, telecast, video or print media reporting or advertising of the event. *
Required
Comments (if needed)
A copy of your responses will be emailed to the address you provided.
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