REGISTRATION

**Please note**
Any fields that are not applicable please enter N/A.

Participant First Name:
Participant Last Name:
Student ID:
Campus:
Team Name:
Team Leader First Name:
Team Leader Last Name:

Name of Team Members:
Member1 First Name:
Member 1 Last Name:
Member 2 First Name:
Member 2 Last Name:
Member 3 First Name:
Member 3 Last Name:
Member 4 First Name:
Member 4 Last Name:
Personal Fundraising Goal
Team Fundraising Goal
Team Health/Fitness Goals
Team Health/Fitness Goal 1:
Team Health/Fitness Goal 2:
Team Health/Fitness Goal 3:
Team Health/Fitness Goal 4:
Team Health/Fitness Goal 5:
Release of Liability Form

This release of liability form must be filled out by each student, staff or faculty member participating in this program. This form may be electronically signed, by checking the box below and typing your name and Student Identification number (faculty and staff please place N/A in ID box).

I agree that I am participating in the HEALTHY BODIES AND STRONG MINDS PROGRAM at my own risk and I agree to abide by all of the terms and conditions established for this program as enumerated either in writing or orally from time to time.

Further, in consideration of my being allowed to participate in this program, on behalf of myself, my heirs, assignees, and personal representatives, I hereby release and forever discharge Everglades University and it’s employees, officers and owners from any and all liability, claim, loss, cost or expense, arising directly or indirectly from or attributable in any legal way to any negligence, action or omission to act of Everglades University or its employees related to the program, including travel to and from any related event, in which I may participate as a student, staff or faculty member.

I agree to make a 100% effort in reaching my goal and collecting all funds pledged to me. I know this is an important cause, and others are counting on me!
Signature:
Date:
 

 

 

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