EmailMe Form - FaithWORKS Participant Registration

Name *

First Last

Age

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Email *

Please select the activities you plan to particpate in

5K Run/Walk

Fitness Classes

Exhibit Area/Seminars

Do you have children that will attend Kids GetFIT?

If yes, please list names and ages

Which T-Shirt would you like to purchase? *

FaithWORKS Tee

5K Run Walk Tee

None

If a T-shirt is chosen you will be redirected to a link to purchase or you may purchase on the website www.faithworkfitness.webstarts.com

Participant Waiver, by typing your name you agree to the terms of this waiver. *

I have been given the opportunity to participate in the FaithWORKS Fitness Expo ("Activity"). I understand that my participation in this activity may involve the risk of physical injury and I am willing to assume any and all such risks. I wish to participate in this activity and recognize that it involves certain dangers through accident or otherwise, including but not limited to physical injury, including death. I HEREBY, RELEASE, WAIVE, DISCHARGE, AND CONVENANT NOT TO SUE any members, employees of the First Church of God, or any business or organizations affiliated with this activity from any and all liability, claims, demands, actions and causes of actions arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or my property, whether caused by my negligence or theirs, while participating in this activity, or being in or upon the premises in which the activity is being conducted. I participate of my own free will. I VOLUNTARILY ASSUME RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that I may sustain or cause as result of being engaged in this activity.