HERO Walk Registration

HERO WALK
Sunday, October 14, 2012
9am Registration
11am Walk
6th & the Boardwalk, Ocean City, NJ

Download HERO WALK pdf

I am joining the HERO Walk as a*
- Team Captain
- Team Member
- Individual Walker
- Virtual Walker
T-Shirt Size*
T-Shirt included with Donation to Walk
Name*
FirstLast
Team
(optional)
Address*
Street AddressAddress Line 2CityStateZip Code
Email*
Enter EmailConfirm Email
Best Contact Phone*
Date of Birth*
Emergency Contact*
Emergency Phone*
- I have been affected by a drunken driving tragedy.
I am walking...
Person's Name
Donation to Walk*
- $20/Adult - HERO Walk
- $10/Student - HERO Walk
- $5/Youth (12 & Under) - HERO Walk
includes T-shirt
Total Price
$0.00
This is the amount that will be charged by Paypal on the payment screen.
My Fund Raising Goal*
Release & Waiver
Release & Waiver Must be Signed by all Participants
In consideration of being permitted to participate in the Hero Walk, I hereby for myself, my heirs and personal representatives, intending to be legally bound, knowingly assume any and all risks of any type or nature, which might be associated with the event. I further waive, forever release, discharge and agree to indemnify, defend and hold harmless the John R. Elliott Foundation and the HERO Campaign for Designated Drivers®, the City of Ocean City, NJ, volunteers, sponsors and others associated with this event, from any and all claims and loss of any kind, including but not limited to claims and loss for injuries or damages (including death), of any kind arising in any way from participation in the Hero Walk. I hereby certify that I have full knowledge of the risks involved in this event, and I am physically fit and sufficiently trained to participate in the Hero Walk. I realize that I am responsible for knowing my own physical limits in participating in this event and will act accordingly. If, as a result of my participation in the Hero Walk, I require medical attention, I hereby give consent to authorize medical personnel to provide such medical treatment and care as deemed necessary.
By checking the box below, I indicate my signature in agreement to the Release and Waiver statement above.*
- I AGREE
Date*
Parent/Guardian Name, if applicable
A parent or guardian must sign if participant is under the age of 18 on the day of the event.

Release & Waiver