Heart Health 5K Walk/Run Registration Form 2025

Heart Health 5K Walk/Run Registration Form 2025
PARTICIPANT INFORMATION
Name*

FIRST NAMELAST NAME
Date of Birth*

MonthDayYear
Date
Address*

ADDRESS

Street Address Line 2

CITYSTATE

ZIP
HOME PHONE
CELL PHONE*
EMAIL ADDRESS
example@example.com
Participating As:*
Shirt Size:*
Emergency Contact Information
Name*

First NameLast Name
Relationship*
HOME PHONE
CELL PHONE*
RELEASE OF LIABILITY
I voluntarily agree to indemnify and hold harmless the City of North Miami Beach against any and all liability, including but not limited to, liability arising out of personal injury, including negligent rescue operations, travel to and from this activity, physical harm or medical claims arising from any activity that I am engaged in while under the supervision of The City of North Miami Beach , and/or their directors, officers, employees, volunteers, representatives, and agents.
I further agree to waive all rights or claims for damages, fees, expenses and attorney's cost with regard to liabilities incurred or brought arising out of any unintentional or negligent acts or omissions of The City of North Miami Beach, and/or their directors, officers, employees, volunteers, representatives, and agents.

I acknowledge that the City of North Miami Beach reserves the right to deny registration to any program, cancel any program and to change fees where applicable. I further understand that I must adhere to all City of North Miami Beach Parks and Recreation Department Policies and Procedures.
By signing this release agreement releasor is waiving certain legal rights which releasor or their heirs, next of kin executors, adminstrators, assigns and representatives may have against The City of North Miami Beach and/or their directors, officers, employees, volunteers, representatives, and agents.
Signature*

Clear
Date*

MonthDayYear
Date
PHOTO/VIDEO RELEASE
I give the City of North Miami Beach permission and my consent to take or use a photograph, videotape, audiotape or film of myself. / agree that these photographsor videotapes may be used in publication on television, over the internet and in the newspapers. I release all claims against the City of North Miami Beach and copyright ownership and publication including any claim for compensation for using the materials and from all claims including liability form or related to the taking use or release of the photograph or video. By signing this document, I acknowledge that I have read and understood the portion entitled PHOTO/VIDEO RELEASE and accept the terms therein.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Heart Health 5K Walk/Run Registration Form 2025

PARTICIPANT INFORMATION

Emergency Contact Information

RELEASE OF LIABILITY

PHOTO/VIDEO RELEASE