Haribon MHW Registration Form (Coke Employees)
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Transcript of Haribon MHW Registration Form (Coke Employees)
REGISTRATION FORM
1. Register by filling up this form completely. Please send all completed Registration forms to:
Victor Z. Manlapaz Project Officer, Environment Coca-Cola Foundation Philippines, Inc. 1890 Paz Guazon Ave. Paco, Manila Tel. (02) 866-2582 Fax (02) 866-2398 Mobile (0917) 886-6054
Forms must be received by the Coca-Cola Foundation no later than October 24, 2008 Friday
2. Registration Fee of P300 per volunteer shall be shouldered by the Coca-Cola Foundation. * Not inclusive of P8 entrance fee to Ninoy Aquino Parks and Wildlife Center
Agreement and Release/Waiver:Please carefully review the following before completing and signing:
In consideration of being permitted to participate in the MILLION HECTARE WALK (the “Event”), I hereby declare, agree and confirm as follows:
1. That I am physically fit to participate in the Event and that i have no medical condition/reason that would restrict my ability to participate in the Event or would cause or aggravate any medical condition.
2. I agree to the use of my picture, name and/or city/town of residence, without compensation, for publicity reasons.
By participating in the Event, I on behalf of myself and those minors (if any) listed below and for whom I am parent and/or legal guardian, hereby release, waive and forever discharge all sponsors, officials, organizers and all other associations involved in the Event, together with each of their respective employees, agents, directors, officers, members and officials(collectively referred to as the “Releasees”), of and from any and all proceedings, claims, demands, damages, costs, expenses, actions and causes of action (whether known or unknown) whatsoever, both in law and equity, which I now have or may hereafter have for or by reason of or in respect of my participation in the Event, whether as a spectator, participant or otherwise, and notwithstanding that same may have been contributed to, or occasioned by, the negligence of any of the Releasees.
I further hereby undertake or hold and save harmless all of the Releasees from and against any and all liability incurred by any or all of them as a result of, or in anyway connected with, my participation and/or the participation of any of the minors listed below in the Event.
By submitting this entry, I acknowledge having read, understood and agreed to the above waiver/release.
The provisions of this agreement, waiver/release shall enure to the respective heirs, executors, administrators, personal representatives, successors and assigns of each of the Releasees and shall be binding upon my heirs executors, administrators and personal representatives.
The provisions of this waiver/release shall be governed by the laws of the Republic of the Philippines.
I am signing this waiver/release on behalf of myself and the following minors (if any) for whom I am a parent and/or legal guardian.
(If under 18 years of age, Parent/Guardian must sign)
Date: ___________________________________________
Signature:___________________________________________ Printed name over Signature
Walker Information:
___ Haribon Member ___ Current ___ For Renewal
____ Non-Member____ Would you like to become a member/donor?
___ Mr ___ Mrs ___ Ms
First Name: _______________________________
Last Name: _______________________________ Age: _________
Address: ________________________________
_________________________________________
Cellphone: (__ __ __ __) __ __ __ - __ __ __ __
Email: ____________________________________
Day-time contact number: __ __ __ - __ __ __ __
Company : Coca-Cola PhilippinesEstimated t-shirt size: S M L XL Other: ________
Which route? _____ Short: 360 meters _____ Long: 1.5km