Wesley Walk for Others

Participant Registration Form

(Waiver and Release Form)

Church _____________________________________  District ___________________

Name ______________________________________________ Age ______________

Address ______________________________________________________________

City/State/Zip_________________________________ Phone ___________________

Email________________________________________________________________

IMPORTANT NOTICE

Participants under age 18 must have this form signed by their parent or legal guardian.

WAIVER

I hereby for myself, my administrators, my heirs and assigns, waive and release any and all rights and claims for damages I have against the organizers of this WALK, their associates and sponsors.  I also agree to obey all traffic laws, exercise all safety precautions, avoid littering and respect the property of others.

_____________________               _______                     __________________________

Participant’s Signature                        Date                               Parent/Guardian Signature

Emergency Contact __________________________Phone _____________________

Coordinator’s Name __________________________Phone _____________________