Need-To-Know Basics
For paper registrations: 1. Fill out the Event Location and Race Date sections on the form beforehand. 2. Provide the participant with a registration form and a pen. They must complete the following sections:
First Name Last Name Date of Birth Email Phone Number Address
Optional sections include: Team Name Military Status Connection to Prostate Cancer Gender T-Shirt Size
Emergency Contact (Name and Phone Number) Participant Waiver (including signature and date)
3. If your event uses numbered bibs, recording the participant’s Name and bib number on your check-in paper is important for emergencies. If your event utilizes blank bibs, encourage participants to fill one out with a message of encouragement or the name of the patient/survivor they are supporting. 4. Once completed, let the participants know they’re all set and kindly welcome them to the ZERO Prostate Cancer Run/Walk!*
Event Location: __________________________________________________________________________________________________________________________
Team Name: ___________________________________________________________________________ Race Date: _______________________________________ Participant First Name: ___________________________________________________ Participant Last Name: ____________________________________________ Date of Birth: __________________ Gender (M/F/Transgender/Non-Binary/No answer): ___________ Email: _____________________________________________ Phone: _______________________ Mailing Address: ___________________________________________________________________________________________ _______________________________________________________ City: ____________________________ State: __________ Zip: ____________________________
2024
T-SHIRT*
Emergency Contact Information (Name and Phone Number): ___________________________________________________________________________________
_______ YM _______ YL
How are you connected to prostate cancer?
Military Status:
_____ I am a caregiver _____ I am a medical professional _____ I work in the medical community _____ I have no connection to prostate cancer Other: _______________________________________
_____ I am a family member of a patient/survivor of prostate cancer _____ I am a friend of a patient/survivor of prostate cancer _____ I am a prostate cancer patient/survivor _____ I am a family member of a loved one lost to prostate cancer _____ I am a friend of a loved one lost to prostate cancer
_______ S _______ M _______ L _______ XL _______ XXL _______ XXXL
____ Active Duty
____ Veteran
____ N/A
Are you interested in volunteering in your local community with ZERO Prostate Cancer? (Yes/No)
*Unisex sizing
Participant Waiver: I have read the participation guidelines and protocols set forth above and agree that I will comply with those guidelines and protocols.I know that running/walking in a road race is a potentially hazardous activity and that I should not enter and run/walk unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run/walk. I as- sume all risks associated with running/walking in this event including, but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. There is a risk that by participating in the ZERO Prostate Cancer Run/Walk, I will have contact with individuals, who have been exposed to and/or have been diagnosed with one or more communicable diseases, including but not limited to COVID-19, and it is impossible to eliminate the risk that I could be exposed to and/or become infected through contact with or close proximity with an individual with a communicable disease; COVID-19 is a contagious disease spread through close contact from person to person that can lead to severe illness and death. According to the Centers for Disease Control and Prevention (CDC), some groups, including older adults and people who have certain underlying medical conditions, are at increased risk of severe illness from COVID-19. Because a run/walk involves the presence of, participation by, and interaction of people, and because there is a risk of exposure to COVID-19 in any place where people are in close contact or physically near one another, I understand and agree that participation in the ZERO Prostate Cancer Run/Walk will be at my and possibly other individuals in my household’s own risk; I fully realize the dangers of participating in the ZERO Prostate Cancer Run/Walk and of interacting and coming into contact with other people, including the potential exposure to COVID-19, and I knowingly and freely assume all such risks associate with participation in the ZERO Prostate Cancer Run/Walk and in interacting with other people, both known and unknown, even if arising from the negligence of the Releasees or others, and assume all full responsibility for my participation; I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation in the ZERO Prostate Cancer Run/Walk, I will remove myself from participation and bring such to the attention of the nearest official immediately; and I, for myself, and on behalf of my heirs, assigns, personal representatives and next of kin, as well as any persons acting by, through, under, or in concert with any of them, (collectively, the “Releasors”) hereby waive, release from liability, discharge, promise to indemnify and not sue, and hold harmless ZERO Prostate Cancer Run/Walk, and all other sponsors or vendors, and their respective officers, board members, directors, officials, agents and/or employees, volunteers, representatives, other participants, sponsoring agencies, sponsors, advertisers, associations, affiliates, and if applicable, owners and lessors of the premises used to conduct the event (“Releasees”), with respect to any and all injury, illness, disability, death, or loss or damage to person or property, arising out of or in connection with participation in the ZERO Prostate Cancer Run/Walk and interaction and contact with other people, whether arising from the negligence of the Releasees or otherwise. Further, I grant permission to all of the foregoing to use my image, name and/or likeness as may be captured in any photographs, motion pictures, recordings, or any other record of this event for promotional and other legitimate purposes. I have read this Release Agreement and I have had sufficient time to consider it and to consult with an attorney, if I so choose, regarding this Release Agreement. I represent and warrant that I fully understand the terms of this Release Agreement, I understand that I have given up substantial rights by agreeing to it on my own behalf and on behalf of my heirs, assigns, personal representatives and next of kin, and I sign it freely and voluntarily without any inducement and without any duress or coercion. I understand that this release is a contract with legal and binding consequences and that it applies to the ZERO Prostate Cancer Run/Walk event that I am requesting permission to participate in.
_______ No Shirt , I’d like to donate the cost of my shirt to help end prostate cancer. T-shirts are available for a $50 donation. Survivors and patients receive a complimentary survivor t-shirt.
Signature: _________________________________________________________________________________________________________________________________ Date: __________________________________
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