Abuse No Longer Silent
Chicago and the Surrounding Suburbs
Step By Step
Race Name: Step by Step, Taking Steps Against Domestic Violence
Benefits: Women and Children of Domestic Violence
Location: Vollmer Road Grove
Name of Event: Step by Step
Distance: 4.5 miles
Date: Saturday October 6th 2012
Start Time: 10:00 am
Registration Fee: For Adults $25.00 or $20.00 with non-perishable food, you must bring with you the day of the event or you will be charged an additional $5.00. High School Students with School ID $15.00, you must show it the day of the walk. Children 12 and under $10.00. Children under six are free with a adult.
Registration will end on September 26, 2012 but in extreme cases, we will except late registration. But with late registration your correct T-shirt size will not be guaranteed. No checks will be accepted at any time during late registration; all other forms of payments will be accepted.
Please fill out a separate registration Form for each Participant
Check-In and late registration starts at 8:00am, you will receive your T-shirt and information packet at that time.
Step 1 of 2 Walker Information
WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK
Please read this form carefully and be aware that in signing up and participating in this event, you are expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this event.
1. In recognition of the risk of injury while participating in the Step by Step Walk-a-Thon Event, Hosted by Awaken Inc. Organization, and as consideration for the right to participate in the event, I hereby for myself, my heirs, executors, administrators, assigns, or personal representatives knowingly and voluntarily enter into this waiver and release of liability(Agreement) and hereby waive any and all right, claims or causes of action of any kind whatsoever arising out of my participating in the event, and do hereby release and forever discharge Awaken Inc. Step by Step Walk-a-Thon and its affiliates, mangers, members, agents, attorneys, employees, volunteers, heirs, representatives, predecessors, successors, and assigns, business, and its affiliates, mangers, members, agents, attorneys, employees, volunteers, heirs, representatives, predecessors, successors and assigns and all sponsors, and/ or beneficiaries of the Event (collectively Host) from any and all liability, claims, demands, damages, actions, or causes of action now existing or which hereinafter may arise as a result of my participation in the event, whether any injury is caused by negligence of the Host, the negligence of myself or third parties, the condition of the course or ant cause.
2. I agree to indemnify and hold harmless the Host against any and all claims, suits or action or any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorneys fees, if litigation arises on account of claims made by me or anyone on my behalf.
3. I attest that I am physically fit and have trained sufficiently for the Event, and that a licensed doctor has recently verified my physical condition. I will not knowingly push beyond my physical limits at any time during this Event.
4. I recognize that various photographs, video, and other media will be taken during the Event. I agree to grant the Host full permission to use any photographs, video recordings, or other media of the Event that contain my likeness for the purpose of promoting Awaken Inc. Organization or the Event, or for any purpose deemed appropriate by the organization.
5. For safety purposes, I agree to refrain from using headphones, (and/or cellular phones) during the Event.
6. I understand that no refunds can be made if the Event is cancelled due to weather conditions or other circumstances beyond the control of Awaken Inc.
7. I acknowledge that this Agreement is the entire agreement between the Host and me, and that this Agreement cannot be modified or changed in any way by representations or statements of the Host or by me.
8. I hereby declare that I have read and fully understand this Agreement in its entirety and that, I understand if by registering on-line, my on-line signature shall substitute for and have the same legal effect as an original form signature. By clicking below (or signing below), I assent to all the terms and conditions contained in this Agreement. I further Agree that this agreement shall be governed by the State of Illinois.
|-OR TO SUBMIT ONLINE-
Fill out the form below
Registration Fee = Adult $25.00 or $20.00 with non- perishable food
High School Student’s with ID $15.00
Children 12 and under $10.00
Please click on the Donate button and it will take you to a secure website on PayPal
where you can use your credit card or your PayPal account. Your information must also be the billing information for the credit card you are using.
If you are paying by check, please make it out to
PO Box 261
Matteson IL. 60443
If you would like to just make a donation to Awaken please follow the same step for registratering for the walk-a-thon. Thank you for your time and your donation.