FUN RUN Registration Form by KevinCrouthers

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									                                                                           In Support of:
                              FUN RUN
                           Registration Form
                                   July 5, 2009

Please use a separate form for each participant.

Name: _______________________________________________                            M/F

Phone:___________________ Address: ___________________________

City:_____________________ Prov:_____ Postal Code:______________

E-mail:_______________________________________________________

Registration is $15.00 Individual

Please return to the attention of Allison Rockwood via:
allisonrockwood@eastlink.ca, fax number 902-468-7912, or mail Soles In
Motion, 121 Ilsley Ave, Dartmouth, NS, B3B 1S4

Wavier of Liability
I understand and agree that by participating in this FUN RUN is a voluntary undertaking.
I understand and agree by participating in this FUN RUN I am voluntarily assuming the
risk of physical injury and death. I agree to release, indemnify and not hold Soles in
Motion and all its employees and volunteers, from any claims, damages or other
liabilities which might result from my voluntary participation in this run. This Release
shall be binding upon me and upon my executors, administrators, personal
representatives, heirs, successors and assigns. I agree to comply with all the rules ad
regulations and event instructors for the safety of my and other participants.

Signature: _________________________________________ Date:_______________________

Parent/Guardian waiver and release for minor
Signiture of Parent/Guardian: _______________________________ Date:__________________

Name of Minor: ___________________________ Relationship to Minor: __________________

								
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