Run for Life |
Registration Form |
Last Name First Name |
Street Address City/State/Zip |
Home Phone Alt. Phone Age Sex |
T-shirt size (please circle) Race Category (please circle) |
S M L XL 1 2 3 4 5 6 7 Run Walk |
Assumption of Risk: Anyone who participates in Greene County Hospital (GCH) activities will be doing so at his or her own risk. GCH is not liable for any accident, injury, loss, or damage to personal property suffered by a participant wile on/in facilities managed by GCH. GCH oes not carry any insurance program to cover participants. Participation in GCH activities is on a voluntary basis. All participants are strongly encouraged to undergo a health evaluation and consult with their personal physician indicating fitness level appropriateness for strenuous activity prior to participating in any GCH activity. |
I have read the above and understand the risks involved. By signing this waiver/release form, I am relinquishing |
Signature____________________________________________________Date_______ |
Signature of Parent (if under 18)______________________________________Date_______ |
Please return this form and registration fee to: |
Radiology Department, c/o Run for Life |
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