Full Name: *

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- Area Code Phone Number

Address:

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Emergency Contact: *

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Age Range: *

Twighlighter/Senior Adult Young Adult (18-35) Teen (13 - 17)* Child (12 and Under)*
*Children under 18 must be accompanied by an adult.
I will be participating in: *

5K Walk/Run Indoor Session Friday Fun Run (Preschool-2nd Grade)
Waiver

Fitness 5K WALK/RUN sponsored by Bible Baptist Church of Kalamazoo, MI

In consideration of accepting my registration form, I have full knowledge of the risks involved and am physically fit to participate in this program. I hereby agree for myself, my heirs, executors and administrators, to waive and release all rights and claims for damages I may have against Bible Baptist Church of Kalamazoo MI, its directors and members or successors, for any injuries suffered by me as a result of participation in this activity. This includes injuries incurred while traveling to, participating in or returning from this event. I agree to indemnify and to hold harmless Bible Baptist Church of Kalamazoo, MI, its directors and members from any liability or expense resulting from my participation in this event.

Photo Release Waiver

I grant, Bible Baptist Church, its representatives/employees the right to take photographs of me and my property in connection with the Fitness Walk/Run. I authorize Bible Baptist, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Bible Baptist Church may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustrations, advertising, and web content.

By clicking on the Submit button below, I acknowledge that I have read and accept the conditions of this participation and photo release waiver.
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