Making Change Happen Global Run 2019

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Team name   First name   Last name   Email address   Age on event date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Gender -- Male Female   Phone #   Address   City   Country   Distance Choose one 5K 10K   Category Choose one Adult Child (12 and under) Infant (2 and under) Choose one Adult Child (12 and under) Infant (2 and under)   Event entry fee TBD

Please tick this box if you would be happy for Reverse Rett to contact you about future similar events  * NoYes   Please tick this box if you would be happy for Reverse Rett to contact you with updates about our work, the impact of your support, and additional ways in which you could get involved  * NoYes

Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver I know that running in a race is a potentially hazardous activity. I should not enter and run in this race unless I am medically able and properly trained. I assume all risks associated with running in the race including, but not limited to, falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the race committee, supporting organizations, Reverse Rett, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the race and/or race activities even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees. I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. EVENT REGISTRATION IS NONREFUNDABLE. If you are registering a child under the age of 18 or an incapacitated adult you represent and warrant that you are the parent or legal guardian of that party and have the legal authority to enter into this agreement on their behalf and by proceeding with this event registration, you agree that the terms of this Agreement and Waiver shall apply equally to all Registered Parties. By registering a child under 13, you agree and consent to the collection of that child's information which you provide for the purposes of registration. By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) having read, understood and agreed to the above waiver. I accept the terms of the waiver Name of parent or guardian who approves this activity Please enter your name here