Shannon McNamara Registration Form 2013 (1).pdf

Additional$5.00feeforraceday registration. October 27, 2013 9:00 am Run 9:05 am Walk 400M Kids Race (free) (10 and Under) after run/walk completion) $15 ADULTS $6 HS STUDENTS & YOUNGER Name_______________________________________________________Age________________ CHECKONEBOX: _________________________ Compe,,veMaleCompe,,veFemaleWalkerBib#(OfficialsOnly) Address_________________________________________________________________________ Street Ci ty S ta te Zip E-MailAddress_________________________________________________ (pleaseprintlegibly) (veryimportantt oincludeemailsoweca nsendyounextyear’ sregistr a,onform) T -shirtguaranteedforpaidregistra,ons receivednolat erthan10/18/13 ShirtSize(cir cleone): S M L XL XXL WAIVER/HOLDHARMLESSAGREEMENT ________ __ herebyagre estoprotect,de fend,indemni fyandsavehar mlessandreimbur seT ownshipHighSchool District214,itsBoar d,officers, agentsandemplo yees(hereina Cerreferredtocolle cvelyas“To wnshipHighSchoolDi strict214”)froman dagainstan yandallloss,clai ms,lawsuits,liabi lity,e xpenses andaIorneys’f eesandcostsof anykindandna turewhatsoever ,whichT ownshipHighSchoolD istrict214mayinc urarisingoutoforin conneconwitha nyclaimeddama ge to,lossordestru conofpropertyor becauseofcla ims,demands,lawsuits,acons,seIle ments,orjudgmentswh atsoeverfor bodilyinjury, sicknessordisease, includingdeath, sustainedbyanypersonresul ngfromorincon neconwithorbyr easonoftheuse ofsaidT ownshipHighSchoolD istrict214bymeor myguestsorinvit ees,includingan ysuch claimorproce edingbasedinwhol eorinpartonan yallegednegli gence,strictliab ility,c ontribuon,indemnityor otherallegaon againstsaidT ownshipHighSchoolD istrict 214exceptthe soleandex clusiveconductof Towns hipHighSchoolDistr ict214.Thepartyin tendsthisindemnifica ontobegiven itsbroadestapplic aontoallcla ims. Datedthis______dayof________________2013.By:______________________________________________________ Signature(Parent/Guardianifunder18) Printandsendcompletedformwithcheck/moneyorderto: Mr.JimVoyles Ro ll i ng Mea dows High S ch ool 2 90 1 W . Ce n tral Ro ad RollingMeadowsIL60008 Pleasemakechecksoutto‘ShannonMcNamaraMemorialScholarshipFund’ Orsignuponline hIps://www.signmeup.com/site/online-event-registraon/95309/SMUalendar

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Transcript of Shannon McNamara Registration Form 2013 (1).pdf

Page 1: Shannon McNamara Registration Form 2013 (1).pdf

Additional$5.00feeforracedayregistration.

October 27, 2013

9:00 am Run

9:05 am Walk

400M Kids Race (free)

(10 and Under) after run/walk completion)

$15 ADULTS

$6 HS STUDENTS & YOUNGER

Name_______________________________________________________Age________________

CHECKONEBOX:_________________________

Compe,,veMaleCompe,,veFemaleWalkerBib#(OfficialsOnly)

Address_________________________________________________________________________

StreetCityStateZip

E-MailAddress_________________________________________________(pleaseprintlegibly)

(veryimportanttoincludeemailsowecansendyounextyear’sregistra,onform)

T-shirtguaranteedforpaidregistra,onsreceivednolaterthan10/18/13

ShirtSize(circleone):SMLXLXXL

WAIVER/HOLDHARMLESSAGREEMENT

___________________________ herebyagreestoprotect,defend,indemnifyandsaveharmlessandreimburseTownshipHighSchoolDistrict214,itsBoard,officers,

agentsandemployees(hereinaCerreferredtocollecvelyas“TownshipHighSchoolDistrict214”)fromandagainstanyandallloss,claims,lawsuits,liability,expenses

andaIorneys’feesandcostsofanykindandnaturewhatsoever,whichTownshipHighSchoolDistrict214mayincurarisingoutoforinconneconwithanyclaimeddamage

to,lossordestruconofpropertyorbecauseofclaims,demands,lawsuits,acons,seIlements,orjudgmentswhatsoeverforbodilyinjury,sicknessordisease,includingdeath,

sustainedbyanypersonresulngfromorinconneconwithorbyreasonoftheuseofsaidTownshipHighSchoolDistrict214bymeormyguestsorinvitees,includinganysuch

claimorproceedingbasedinwholeorinpartonanyallegednegligence,strictliability,contribuon,indemnityorotherallegaonagainstsaidTownshipHighSchoolDistrict

214exceptthesoleandexclusiveconductofTownshipHighSchoolDistrict214.Thepartyintendsthisindemnificaontobegivenitsbroadestapplicaontoallclaims.

Datedthis______dayof________________2013.By:______________________________________________________

Signature(Parent/Guardianifunder18) Printandsendcompletedformwithcheck/moneyorderto: Mr.JimVoyles

RollingMeadowsHighSchool 2901W. CentralRoad

RollingMeadowsIL60008

Pleasemakechecksoutto‘ShannonMcNamaraMemorialScholarshipFund’

OrsignuponlinehIps://www.signmeup.com/site/online-event-registraon/95309/SMUalendar