Team Name * MUST HAVE TO FILL IN FORM Participant Name * First Last Name * Last Phone Number * Email Address * T-Shirt Size * Small Medium Large X-Large 2X-Large 3X-Large As a non-member participant at The Center for Individuals with Physical Challenges [“The Center”], each person for himself, his heirs, assigns, spouse, minor children and personal representatives specifically assumes any risk inherent, including the risk of contracting COVID-19 or another communicable disease, in any activity actually existing on or about the premises used by The Center. The Center staff, volunteers, Board of Directors and its officers assume no liability whatsoever for any accident or injury whether personal or otherwise arising from operation of The Center or conduct of or for The Center. Each non-member participant agrees specifically for himself, his heirs, assigns, spouse, minor children and personal representatives to hold harmless The Center staff, volunteers, Board of Directors and its officers and for any and all Center activities, equipment or Center-used premises. Further, I accept full responsibility for informing The Center staff of any participation limitations of which they should be aware in reference to my involvement. I agree to be governed by The Center’s bylaws, rules and regulations, including the above “hold harmless clause.” I have read this agreement and waiver and am fully familiar with its contents. I hereby release The Center from any and all liability resulting from my use of the facility and assume all risks in connection therewith including known and unknown risks. I grant The Center permission to use my name, photo and/or likeness in any public relations, marketing or fundraising materials. * Yes No I am 18 years or older. * Yes No Initials * If you are human, leave this field blank.
