2025 Stiletto Breast Cancer Walk Registration Form

Name*

First NameMiddle NameLast Name

Are you a City of Hallandale Beach employee?*

Birth Date*

MonthDayYear

E-mail*

example@example.com

Gender*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Number*

Company/ Agency Affiliation

Phone Number

Please enter a valid phone number

Work Number

Will you have a minor with you?*

Are you the parent/legal guardian of the minor? Only Parents/Legal guardians can register minors *

If applicable, please include the minors name below. If not, place N/A in the box below. *

Name of minor to participate in the walk- Please include First- Middle- Last Name

Would you like to get information on upcoming events?*

Last day to register- October 4, 2025

Event date: October 4, 2025

Registration begins: 8:00 am

Event start time: 8:30 am

Event Location: 1000 NW 8th Avenue, Hallandale Beach, FL 33009

Stiletto Breast Cancer Walk Cash Registration Fee:

$20.00 ($5.00 for seniors 60+)

Payment is CASH ONLY. Payment will be collected the day of the event. Proceeds benefit a local cancer organization or patient.

Disclaimer:

I agree to terms & condition.

-CITY OF HALLANDALE BEACH HUMAN SERVICES DEPARTMENT STATEMENT/FIRE N DEZIRE AND WAIVER OF LIABILITY In the event of an emergency, the undersigned gives permission to receive any necessary medical treatment, and the undersigned will be responsible for payment of all related bills. To the City of Hallandale Beach and Fire N Dezire: In consideration of the opportunity afforded to the named participant(s) in City of Hallandale Beach Human Services Department and Fire N Dezire Event, I, the undersigned, hereby acknowledge, freely and voluntarily RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE THE CITY OF HALLANDALE BEACH and Fire N Dezire, its officers, agents, employees and volunteers from any and all liability or claims which may be sustained directly or indirectly in connection with, or arising out of, the undersigned’s participation in the Event, whether caused in whole or in part by the negligence of the City of Hallandale Beach, Fire N Dezire or otherwise. The undersigned, on behalf of myself and my child or ward, shall save harmless the City of Hallandale Beach and Fire N Dezire from and against all judgments, orders, decrees, attorney’s fees, costs, expenses and liabilities arising from or out of such claim, investigation, or defense thereof which may be entered, incurred or assessed against the City of Hallandale Beach and Fire N Dezire as a result of the foregoing. I, THE UNDERSIGNED, HAVE READ THIS DOCUMENT, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I, ON BEHALF OF MYSELF AND THE MINOR CHILD DESCRIBED HEREIN, HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ANY AND ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS DOCUMENT IS HELD TO BE INVALID THE BALANCE NOTWITHSTANDING, SHALL CONTINUE IN FULL LEGAL FORCE AND EFFECT.

-HOLD HARMLESS AND INDEMNIFICATION The undersigned agrees to indemnify and hold harmless the City of Hallandale Beach and Fire N Dezire, its officers, employees and officials (and, at the City’s discretion, undersigned will provide defense or pay for legal counsel selected by the City and Fire N Dezire to represent the City and its officers, officials and employees) for, from and against all claims, action, or cause of actions, losses, damages, liabilities, costs and expenses, including costs, attorneys’ and paralegals’ fees and fees of experts, imposed on or incurred by the City and Fire N Dezire in connection with any and all loss of life, bodily injury, and damage to property which arises, relates or pertains to directly or indirectly, undersigned acts or omissions (including negligent acts or omissions) with respect to participation in the event.

-PHOTOGRAPHY WAIVER AND RELEASE FORM The City of Hallandale Beach and Fire N Dezire periodically uses photographs, videos, profiles and stories for programs that are promotional, advertising, commercial, educational, research and/or archival in nature. As such, the City of Hallandale Beach and Fire N Dezire continually collects individual and group photos and testimonials relating to our volunteers, supporters, vendors, events, and activities in Hallandale Beach and Fire N Dezire. We ask for permission to use your photo, profile and/or story in promotional material to promote and benefit our projects and programs. I hereby grant the CITY OF HALLANDALE BEACH and Fire N Dezire, its commissioners, legal representative, officers, employees, agents, representatives, successors, licenses, consultants, contractors and assign the irrevocable right and unrestricted permission to use and publish photographs or video images of me, or in which I may be included for any purpose authorized by the CITY OF HALLANDALE BEACH and Fire N Dezire, including but not limited to: website use, editorial publications, catalog and advertising use, without payment or any other consideration. I understand that the circulation of such materials could be worldwide and there will be no compensation to me for this use. I understand that I will not be given the opportunity to inspect or approve the finished products or the advertising copy or the printed matter that may be used in connection therewith. I therefore waive the right to inspect or approved the finished product, including written or electronic copy, wherein my likeness appears. I further understand and agree that these materials will become the property of the CITY OF HALLANDALE BEACH and Fire N Dezire and will not be returned. I hereby irrevocably authorize the CITY OF HALLANDALE BEACH and Fire N Dezire and/or any third party acting on the CITY’S and Fire N Dezire’s behalf to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing programs or for any other lawful purpose. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge the CITY OF HALLANDALE BEACH and Fire N Dezire from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other person acting on my behalf or on behalf of my estate have or may have in the future by reason of this authorization. In granting this permission and release to the CITY OF HALLANDALE BEACH and Fire N Dezire its legal representative, I am fully and without limitation releasing it from any liability that may arise from the use of the images. I am 18 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

Signature*