Integrity Children's Fund
Annual Youth Education 3 K Walk
Walker Registration Form
AUGUST 17, 2013
Wills Park, Alpharetta, Ga.
“Lions Pavilion”
www.willspark.com
P.O. Box 4402
Alpharetta, GA 30023
www.integritychildrensfund.org
678-591-7764 Phone
678-682-9863 Fax
11925 Wills Rd, Alpharetta, Ga. 30009
Picnic activities starts at 2:00pm. Walk starts at 5:00 pm
Walker’s Name
Street Address
City
State
Zip
Tele #
Email Address
Sex
Emergency Contact
Age
Male/Female
Name
T-Shirt Size: XS S M L XL XXL
Telephone
I wish to participate in Integrity Children’s Fund non-competitive pledge walkathon and related events. I understand it is my
responsibility to seek, on a best effort basis, financial pledges and donations payable to Integrity Children’s Fund, which are due
on or before the day of the walkathon. I understand that all pledges are non-refundable, even if I do not participate in Integrity
Children’s Fund Walkathon.
WAIVER OF NEGLIGENCE & COMPLETE RELEASE OF LIABILITY
I understand that by participating, I will be using public places, public streets and facilities where many hazards exist and I am
aware of and appreciate the risks, which may result. I am voluntarily participating in this event with knowledge of the dangers
involved and I agree to accept any and all risks of injury or death.
I agree to assume all risk and to release and hold harmless Integrity Children’s Fund and their affiliated organizations, sponsors,
officials, communities, participating clubs, government or public entities. I am physically capable of participating in Integrity
Children’s Fund. If I am aware of or under treatment for any physical infirmity, ailment or illness, my medical care provider
knows of and has approved my participation in Integrity Children’s Fund Walkathon. I acknowledge that I, and I alone, am
solely responsible for my personal health and safety, and the personal property I bring with me.
I will read and abide by all rules and regulations established by Integrity Children’s Fund Walkathon organizers and personnel.
I understand that my name, photograph, voice or likeness may be used by Integrity Children’s Fund and their affiliates. I
consent to and authorize, in advance, such use and waive my rights of privacy I have in connection therewith.
I have carefully read this Waiver and Release and fully understand its contents. I am aware that this is a RELEASE OF
LIABILITY and a contract between me and the persons and entities mentioned above and all of their respective officers,
directors, agents and representatives and I sign it of my own free will.
THIS IS AN IMPORTANT LEGAL DOCUMENT. READ IT CAREFULLY BEFORE SIGNING BELOW.
_________________________________
______________________________
Walker Signature
Date
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Parent or Guardian Signature (if under 18 years of age)
________________________________
Date