Kiwanis Club of Kankakee


Please visit our website for more information www.kkiwanis.org

Name:
Address:
City:
Phone:
Age on 10/26:
Gender: Male Female
E-mail address:
Race Course: 5k run
2 mile walk
  100 yd dash 1/2 mile run
Registration:  Run/Walk $25 Youth Races $10
(Free shirts to first 150 registrants)
Shirt Size:     Youth M     Youth L     S     M    L    XL    XXL
I want to add additional family member(s).
Family Discount:  3 or more, $10 discount.
Participant/Parent/Guardian Signature:
By checking the box you have created an electronic signature as legally binding as your hand-written signature.


WAIVER AND RELEASE FROM LIABILITY: Participation in the Kiwanis Winter Warmup 5k Run and 2 mile walk and children’s runs is a physical activity that should not be entered into unless you are physically fit and sufficiently trained to participate. I assume all risks associated with participating in this event including, but not limited to: falls, contact with other participants, the effect of the weather, and the conditions of the path/course. For, and in consideration of my participation in the Kiwanis Winter Warmup 5k Run and 2 mile walk and children’s runs, I, myself, my executors, administrators, heirs, and assignees do hereby release and discharge, the Kiwanis Club of Kankakee, the Bourbonnais Township Park District, the race committee and all sponsors, agencies, subsidiaries, affiliates and beneficiaries, jointly and severally and hold and waive harmless from and against any and all actions, claims, injuries, demands, liabilities, loss, damage or expenses of whatever kind and nature including, but not limited to, attorney fees which at any time may be incurred by reason of my participation in or my preparation for any of the foresaid events. I attest and verify that I have full knowledge of the risks involved in this event, and I am physically fit and sufficiently trained to participate. The undersigned grant full permission to any and all foregoing use of his/her likeness, including photographs, videotape and electronic images for publicity and advertising purposes without compensation.