PROJECT ONE MILLION ANNUAL HEALTH & WELLNESS DRUG FREE WALK REGISTRATION FORM
Date: August 1, 2026 Time: 8:00 am CST Venue: 902 S. 2nd St., Kingsville, TX 78363
Name
First Name
Middle Name
Last Name
Date of Birth:
Sex
Please Select
Male
Female
N/A
List all the names and Tshirt sizes of adults and children who will be participating in the 5K Walk event. Please indicate whether it is youth or adult Tshirt for each participant.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
example@example.com
Contact Number
Format: (000) 000-0000.
In Case of Emergency
Emergency Contact:
First Name
Last Name
Relationship
Contact Number
Format: (000) 000-0000.
Payment and Release of Liability
Release and Waiver of Liability - Assumption of Risk and Indemnity Agreement
In consideration of my participation in the Douglass Youth Center Project One Million Walk, I, the undersigned participant, hereby acknowledge and agree to the following:
*
I am fully aware of the risks involved in participating in a Douglass Youth Center Project One Million Walk and voluntarily assume all such risks.
I am physically fit and have no medical condition see that would prevent my participation in the Douglass Youth Center Project One Million Walk.
I agree to comply with all rules and regulations of the Douglass Youth Center Project One Million Walk.
Participants must understand that Douglass Youth Center or Board of Directors, Sponsors, Volunteers, and Representatives are not liable for injuries, losses, or damages of any kind that may arise during or at the Douglass Youth Center Project One Million Walk. Douglass Youth Center and volunteers of the Project One Million does not discriminate against race, ethnicity or handicapped. Registration fee for participant is non-refundable, if a fee should occur..
I have release Douglass Youth Center, Project 1 Million sponsors, any members affiliated with Project 1 Million, or employees from ANY liability resulting from injury suffered by me or my child. My signature acknowledges that I understand my private insurance will cover any charges incurred for medical treatment.
Date
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Month
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Day
Year
Date
Signature
Register
Register
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