Empoweringthepoor.org - SPONSORSHIP COMMITMENT FORM-3RD

Empoweringthepoor.org - Empowering the Poor Communities to Self-Reliance and Dignity

	Theme: Rain or Shine, we Run and Walk because every 30 seconds a child dies from malaria in Africa.
	Date: Sunday, April 22nd, 2007
	Where: Downtown Fredericksburg Rappahannock Library (1201 Caroline street) Time: 7:30AM Sponsor, Run, or Walk and you automatically become a WINNER. All participants will receive free T-shirt, sun-visor, refreshments, etc. Register Now!!!! Click here to register Run/Walk Against Malaria

3RD ANNUAL EMPOWERING THE POOR’S MALARIA RUN WALK FREDERICKSBURG 2008

Malaria Run Walk Agreement, Release, Waiver, Parental Consent Form

This form must be signed by the parent or legal guardian
of a participant under the age of 18 in order for the minor
to be eligible to participate in the Malaria Run Walk.

I, (Name of Parent or Legal Guardian), am the Parent or Legal Guardian of (Child’s name).
I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in this event. I am a voluntary participant in this event, and in good physical condition. I hereby assume full and complete responsibility for any injury or accident which may occur during my participation in this event or while on the premises of this event, and I hereby release and hold harmless and covenant not to file suit against Empowering The Poor, Inc and any affiliated individuals, Empowering The Poor, Inc. and any affiliated individuals, and any walk sponsors and their agents and employees, and all other persons or entities associated with this event from any loss, liability or claims I may have arising out of my participation in this event, including personal injury or damage suffered by me or others, whether same be caused by falls, contact with participants, conditions of the course, or otherwise. If I do not follow all the rules of this event, I understand that I may be removed from the Malaria Run Walk.
I give my full permission to Empowering The Poor, Inc and their corporate partners to use any photographs, videotapes, or other recordings of me that are made during the course of this event.
PARENTAL CONSENT:
This consent serves as permission for (Child’s name) to participate in the Malaria Run Walk, and I hereby execute the above Agreement, Waiver, and Release on his/her behalf. I state that said minor is physically able to participate in the Malaria Run Walk. I hereby agree to indemnify and hold Empowering The Poor, Inc. and any affiliated individuals, sponsors, and all persons or entities associated with this event free and harmless from any loss, liability, damage cost or expense which they may incur as the result of the death or any injury or property damage that said minor may sustain while participating in the Malaria Run Walk.
I have carefully read this Agreement, Waiver, and Release and fully understand its contents I am aware of its contents and I sign it of my own free will.

Signature of Parent:	I accept conditions
Parent/Guardian Name:
Date:

Empoweringthepoor.org -2006- All rights reserved. Empowering The Poor, Inc. (ETP) is a non-profit and charitable organization under section 501 (3) of the U.S. Internal Revenue Code. All contributions are tax deductible to the extent permitted by the law. Powered by CQube Data Systems