Author: lke

Join Together Atlantic County
Board“Walk” for Recovery
& Sober Beach Picnic
(Walk is 1.5 miles)
Saturday, September 26, 2015
Albany Ave and the Boardwalk, Atlantic City, NJ
10:00am Registration•11:00am Walk
12:00pm—2:00pm Picnic
(Bring your beach gear)
Day of Event First 150 Walkers Receive a Free T-Shirt

I am joining the Board“Walk” for Recovery as a:
 Team Captain  Team Member
 Individual/Family Walker  Donor
Name_________________________________ Team (optional)___________________________________
Address________________________________ City/State/Zip___________________________________
Contact Phone__________________________ Date of Birth ______/______/______________________
E-Mail Address__________________________________________________________________________
Emergency Contact_______________________ Emergency Phone__________________________________
If participant is under the age of 18 on the day of the event you must print and bring this form with you to the Board“Walk”
Release and Waiver Must Be Signed By All Participants.
In consideration of being permitted to participate in the Board“Walk” for Recovery, I hereby for myself, my heirs and personal representatives, intending to be legally bound, knowingly assume any and all risks of any type or nature, which might be associated with the event. I further waive, forever release, discharge and agree to indemnity, defend and hold harmless Join Together Atlantic County, the City of Atlantic City, NJ, volunteers, sponsors and others associated with this event, from any and all claims and loss of any kind, included but not limited to claims and loss for injuries or damages (including death), of any kind arising in any way from participation in the Board“Walk” for Recovery. I hereby certify that I have full knowledge of the risks involved in this event, and I am physically fit and sufficiently trained to participate in the Board “Walk” for Recovery. I realize I am responsible for knowing my own physical limits in participating in this event and will act accordingly. If, as a result of my participation in the Board “Walk” for Recovery, I require medical attention, I hereby give consent to authorize medical personnel to provide such medical treatment and care as deemed necessary.
Signature _________________________ Date______________________
A parent or guardian must sign if participant is under the age of 18 on the day of the event
Print Parent/Guardian name if applicable ____________________________________________