Registration Form (Drop Entry at Annex or Surf City Surf Shop or sign up on-line at http://kidsmakingit.org/ )
Name:_____________________________________Phone:______________________E-mail____________________________________
Address:___________________________________City:________________________State:______Zip:___________________________
Donation:____________ ($20 minimum donation) Please Make Checks Out to Kids
Making It
Emergency Contact Name & Phone:__________________________________
Hold Harmless Release: This release bars your rights to recover damages in the case of an accident injuring you.
Read Before Signing: In applying to Walk A Mile In Mile In Socks, Annex, Surf City Surf Shop, Crane Inc., Stance, Inc., Kids Making It, Inc., Halcyon Enterprises, Inc., Functional Art
Movement, fund raising event, I promise to inspect the event site, and assure myself that the area is safe for participating, and further agree that I will not participate in the event unless I am
satisfied that the area and conditions are safe for participating in event. In exchange for Walk A Mile In Mile In Socks, Annex, Surf City Surf Shop, Crane Inc., Stance, Inc., Kids Making It, Inc.,
Halcyon Enterprises, Inc., Functional Art Movement,, accepting my donation fee and registration/entry form, I voluntarily agree to assume all risks incident to the Walk A Mile In My Socks
event. I will further agree that, noting existing weather conditions, I voluntarily assume all risks arising from conditions related to use of the event site by myself and others. I give Walk A Mile
In Mile In Socks, Annex, Surf City Surf Shop, Crane Inc., Stance, Inc., Kids Making It, Inc., Halcyon Enterprises, Inc., Functional Art Movement, permission to arrange to telecast, show, or print
and publish any and/or all pictures taken of me (movie, video, or still) in conjunction with said event. In consideration of your acceptance of my registration/entry, I intend to be legally bound,
hereby, for myself, my heirs, executors, and administrators, hold harmless and release and forever Walk A Mile In Mile In Socks, Annex, Surf City Surf Shop, Crane Inc., Stance, Inc., Kids
Making It, Inc., Halcyon Enterprises, Inc., Functional Art Movement,, Wrightsville Beach, New Hanover County, State of North Carolina, their members, agents, and any officials connected
with this event, from all liabilities for injuries and damages whatsoever, arising from my presence or participation in the above described event and do hereby grant the sponsors such release as
described herein. I acknowledge that I have read and understand all of the above.
Signature of Participant:
Date:______________________________
For Participants Under 18 Years of Age: I HEREBY CERTIFY that I am the parent or guardian of the participant named above and do hereby give my permission without reservation and with
full understanding and comprehension of the aforegoing agreement to hold the aforementioned organizations and government entities harmless any and all liabilities including any such injuries
which are alleged to have occurred as a result of negligent failure of Walk A Mile In Mile In Socks, Annex, Surf City Surf Shop, Crane Inc., Stance, Inc., Kids Making It, Inc., Halcyon
Enterprises, Inc., Functional Art Movement, event personnel, volunteers, and directors to properly supervise participants in the course of this event.
Signature of Parent or Guardian:
Date:_______________________________
Keep For Your Records
Date – Thursday, April 24th
Time – 5 PM Check-In
Place - Annex - 534 Causeway Dr, Wrightsville Beach, NC 28480 (next to Surf City Surf Shop)