Ada Jenkins Center Walk-a-Thon Registration

* Name:
First
Last
Team Name:
* Address:
* City:
* State:
* ZIP:
* Email:
* Age:
Parent/Guardian:
If you're under 18, please enter your parent or guardian's name above.
* Waiver and Release: In consideration of my being admitted to enter the "Ada Jenkins Center Walk-a-thon", I, for myself, my heirs, and assigns, executors and administrators, do hereby forever release and discharge "The Ada Jenkins Center" their employees and agents, of and from any and all claims or demands for damages, injuries, or liability, in any manner arising out of participation in this event. I agree to indemnify and hold harmless the parties released above from any claims or demands for damages, for injuries or liability, in any way arising out of my participation in this event. I certify that I have prepared myself for this walk and that I am in adequate physical condition to complete the event I have entered. I agree to follow all rules of this walk and permit myself to be removed from the competition if in the opinion of walk officials that continuing would endanger my health.
 
* Indicates a required field.