5K Walk for Sickle Cell on-line registration
*required information

*Name:
Age:
Gender:
T-SHIRT SIZE:
(pick only one)
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
*EMAIL:
EMERGENCY
CONTACT:
EMERGENCY
PHONE#:
If Registering a Team
TEAM or COMPANY NAME:
*Security Question:
to prevent spam




see waiver

Sickle Cell Walk Registration Form




WHEN:           Saturday, September 7, 2013 On-Site Registration begins 7:00 AM - Walk begins 8:00 AM

WHERE:        514 North DeVilliers Street Pensacola, Florida

COURSE:      Thru the historic Belmont/DeVilliers neighborhood, thriving downtown
                         Pensacola, plus scenic Palafox Pier.

Substations with water and first aid will be available!!!!

Name:_________________________________________Age:______Gender:     M       F                                                                                                                                 
T-Shirt Size (circle one):     S    M     L    XL      XXL       XXXL                                

Address:_______________________________________________________________

City:__________________________________State:____________Zip:_____________

Phone:_______________________Email:_____________________________________

Emergency Contact:_________________________Phone#:______________________

Team Registration---Team or Company Name:___________________________ How many walkers?________

Additional Names_______________________________________________________________________________________

                               _______________________________________________________________________________________

PLEASE NOTE: For the safety of all participants, strollers, skateboards, scooters, skates and dogs (unless service animal) are prohibited from this event.
Standard Waiver (must be signed by all participants):  I KNOW THAT WALKING A COURSE IS A POTENTIALLY HAZARDOUS ACTIVITY WHICH COULD CAUSE INJURY OR DEATH. I SHOULD NOT ENTER UNLESS I AM MEDICALLY ABLE AND PROPERLY TRAINED. BY MY SIGNATURE, I CERTIFY THAT I AM MEDICALLY ABLE, I AM IN GOOD HEALTH TO PERFORM THIS EVENT AND PROPERLY TRAINED.  I AGREE TO ABIDE BY ANY DECISION OF A WALK OFFICIAL RELATIVE TO ANY ASPECT OF MY PARTICIPATION IN THIS EVEVT, INCLUDING  THE RIGHT OF ANY OFFICIAL TO DENY OR SUSPEND MY PARTICIPATION FOR ANY REASON WHATSOEVER. I ASSUME ALL RISKS ASSOCIATED WITH WALKING IN THIS EVENT, INCLUDING BUT NOT LIMITED TO FALLS, CONTACT WITH OTHER PARTICIPANTS, THE EFFECTS OF WEATHER, INCLUDING COLD, HEAT AND HUMIDITY, TRAFFIC, AND THE CONDITIONS OF THE ROAD, ALL SUCH RISKA BEING KNOWN AND APPRECIATED BY ME. I UNDERSTAND THAT BICYCLES, SKATEBOARDS, SKATES OR BLADES, ANIMALS, AND RADIO/TAPE/CD HEADSETS ARE NOT ALLOED IN THE EVENT AND WILL ABIDE BY THIS GUIDELIN E. HAVING READ THIS WAIVER AND KNOWING THESE FACTS AND IN CONSIDERATION OF YOUR ACCEPTING MY ENTRY, I, MYSELF AND ANYONE ENTITLED TO ACT ON MY BEHALF, WAIVE AND RELEASE SICKLE CELL DISEASE ASSOCIATION AND THE CITY OF PENSACOLA AND ANY NATIONAL GOVERNMENT ENTITY RESPONSIBLE FOR AREAS USED IN CONJUNCTION WITH THIA EVENT, AND ALL SPONSORS, THEIR REPRESENTATIVES AND SUCCESSORS FROM ALL CLAIMS OR LIQABILITIES OF ANT KIND ARISING OUT OF MY PARTICIPATION IN THIS EVENT, EVEN THOUGH THAT LIABILITY MAY ARISE OUT OF NEGLIGENCE OR CARELESSNESS ON THE PART OF A PERSON NAMED IN THIS WAIVER. FURTHER, I GRANT PERMISSION TO ALL THE FORGOING TO USE MY NAME AND IMAGES OF MYSELF IN ANY PHOTOGRAPHS, MOTION PICTURES, RESULTS, PUBLICATIONS OR ANY OTHER PRINT, VIDEO GRAPHIC OR ELECTRONIC RECORD OF THIS EVENT FOR LEGITIMATE PURPOSES. I HAVE READ THE ABOVE RELEASE AND UNDERSTAND THAT I AM ENTERING THIS WALK AT MY OWN RISK.

Signature:______________________________________________ Date:_____________________
(Parent or guardian, if under 18 years of age)