P. 1
Registration form & waiver for America's Finest Flippin 5k!!

Registration form & waiver for America's Finest Flippin 5k!!

|Views: 26|Likes:
You may register online at active.com, but if you would rather do a paper registration, here it is! Contact me for pick up, or you can drop it off at America's Finest Gymnastics in Statesboro, GA.
You may register online at active.com, but if you would rather do a paper registration, here it is! Contact me for pick up, or you can drop it off at America's Finest Gymnastics in Statesboro, GA.

More info:

Published by: Shannon Haygood Sikes on May 08, 2013
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

05/08/2013

pdf

text

original

America’s Finest Flippin’ 5K

Participant Waiver
This release and waiver is executed on May 18
th
2013. Knowingly, and at my own risk, I
am participating in the America’s Finest Flippin’ 5K. I do hereby waive release any and all
claims against America’s Finest Gymnastics, Georgia Southern University, all event sponsors
and any employee, volunteer, or officials of these organizations from any claim of injury
(including death) that I may incur as a result of my participation in this event.
I further hereby certify that I have fully knowledge of the risks involved in this event,
and I am physically fit and sufficiently trained to participate. If, however, as a result of my
participation in the America’s Finest Flippin’ 5K, I require medical attention, I hereby give
consent to authorize medical personnel to provide such medical care as deemed necessary.
Printed Name of Participant: __________________________________________
Signature of Participant: ______________________________________________

Registration Form

First Name: ________________________________________________________________
Last Name: ________________________________________________________________
Gender: Male or Female (circle)
Birthdate: ___/____/___
Email: ____________________________________________________________________
Day Phone Number: _____________
Evening Phone Number: ______________
Address: __________________________________________________________________
City: ____________________ State: _____________ Zip Code: ___________
Tshirt Size: ___________ (YS, YM, YL, AS, AM, AL, AXL)
Gymnast Name: ___________________________________________________________
Make checks payable to “AFG Booster Club”

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->