#QUEENSNEVERQUIT WALK :: ON-SITE REGISTRATION FORM NAME:
_________________________________________________________________
EMAIL ADDRESS:
_________________________________________________________________
PHONE:
_________________________________________________________________
By completing your registration, you agree and will comply with the following waiver statement: "In consideration of being permitted to participate in the Queens Never Quit Walk, I hereby assume for myself, my heirs, and my personal representatives, any and all risks which might be associated with the event. I further waive, release, and discharge representatives or their successors for any injuries or damages of any kind whatsoever suffered as a result of taking part in this event and any related activity. I hereby grant full permission to any and all foregoing to use my name and photos or video for publicity and/or promotional purposes without obligation or liability to me." SIGNATURE: _________________________________________________________________ If you do not agree to this statement, PLEASE SPEAK TO A VOLUNTEER AT THE CHECKIN/REGISTRATION AREA. Thank you! _____________________________________________________________________________________
#QUEENSNEVERQUIT WALK :: ON-SITE REGISTRATION FORM NAME:
_________________________________________________________________
EMAIL ADDRESS:
_________________________________________________________________
PHONE:
_________________________________________________________________
By completing your registration, you agree and will comply with the following waiver statement: "In consideration of being permitted to participate in the Queens Never Quit Walk, I hereby assume for myself, my heirs, and my personal representatives, any and all risks which might be associated with the event. I further waive, release, and discharge representatives or their successors for any injuries or damages of any kind whatsoever suffered as a result of taking part in this event and any related activity. I hereby grant full permission to any and all foregoing to use my name and photos or video for publicity and/or promotional purposes without obligation or liability to me." SIGNATURE: _________________________________________________________________ If you do not agree to this statement, PLEASE SPEAK TO A VOLUNTEER AT THE CHECKIN/REGISTRATION AREA. Thank you!