EMBRY CHAPEL AME CHURCH

SPIRITWALK - AUGUST 19, 2017

CENTERVILLE COMMUNITY PARK

          1350 N 400 W Centerville, UT 84014         

REGISTRATION FORM

SEX *
REGISTRATION FEE NOTE: T-SHIRT INCLUDED UP TO SIZE: S   M  L   XL 1X; 2X & OVER, ADDITIONAL $3.00. *
PLEASE INDICATE SIZE. *
 

Payment accepted by Paypal, Cashier's Check or Cash

Place the cost of the purchase below.
Mail cash or cashiers check to:
Embry Chapel AME Church
264 30th St, Ogden, UT 84401
Participant under age 18 MUST have Parent/guardian’s signature:
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IN CASE OF EMERGENCY PLEASE CONTACT:

EMBRY CHAPEL AME CHURCH

SPIRIT WALK – 2017

RELEASE AND WAIVER OF LIABILITY AGREEMENT

I acknowledge that I have voluntarily applied to participate in the following activities: Walking, warm-up, stretching, during the Women’s Missionary Society Spirit Walk:

I AM AWARE THAT THESE ACTIVITIES COULD BE HAZARDOUS ACTIVITIES (ALWAYS CHECK WITH YOUR PERSONAL PHYSICIAN BEFORE PERFORMING PHYSICAL ACTIVITTIES) AND THAT I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE POSSIBLE INJURY COULD BE INVOLVED, AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN.

As consideration for being permitted by the EMBRY CHAPEL AME CHURCH, State of Utah, the County of Davis, and any lessor of the fair premises (“Lessor”), to participate in these activities and use the Fair premises and facilities. I forever release the Embry Chapel AME Church, the Lessor, organization and their respective directors, officers, employees, volunteers, agents, contractors, and representatives (collectively “Releasees”) from all actions, claims, or demands that I, my assignees, heirs, distributes, guardians, next of kin, spouse and legal representatives now have, or may have in the future, for injury, death or property damage, related to (i) my participation in these activities, (ii)the negligence or other acts, whether directly connected to these activities or not, and however are used, by any Releasees, or (iii) the condition of the premises where these activities occur, whether or not I am then participating in these activities. I also agree that I, my assignees,, heirs, distributes, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND EMBRY CHAPEL AME CHURCH AND THE LESSOR, AND SIGN IT OF MY OWN FREE WILL.

If Signed by Parent or Guardian: I verify that the dangers of the activities and the significance of this Release and Waiver were explained to the Participant and the Participant understood them.

BY SIGNING BELOW, YOU CERTIFY THAT YOU HAVE READ THIS AGREEMENT, THAT YOU KNOW AND UNDERSTAND THE MEANING AND INTENT OF THIS AGREEMENT AND THAT YOU ARE ENTERING THIS AGREEMENT KNOWINGLY AND VOLUNTARILY.
PARTICIPANT
 *
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RELEASOR PARENT OR GUARDIAN
Place the cost of the purchase below.