1. health and fitness
2. disease
3. infertility

Redlands Hunger Walk—Stepping Up to Stop Hunger
Saturday, June 6, 2015 at 8am
University of Redlands/Chapel
1200 E. Colton Avenue, Redlands, CA 92374
Form
!Registration Fee Registration
$30.00, late registration on the day of the event $35.00, 12 years and younger – canned food
donation. The registration fee will be waived for Sponsorship/Pledges $100 and over. Please make your checks
payable to Family Service Association of Redlands. You may also pay your registration amount on our website
using PayPal. Please reference the Hunger Walk and registration. For more details about the Hunger Walk,
please visit www.redlandsfamilyservice.org. If you have any questions contact Kyra Stewart by phone at
909 793-2673 x 111 or email [email protected].
!Last Name
!Address
City, State, Zip
Telephone Number
Email Address
First Name
!
1. Emergency Contact Name and Phone Number
2. Emergency Contact Name and Phone Number
Ages: Under 20 T-­‐Shirt Size: Small 20 -­‐ 29 30 -­‐ 39 Medium 40 -­‐ 49 Large !!
Waiver (must be signed in order to participate):
50 -­‐ 59 Extra Large 60+ Gender: Youth Small Male Female Youth Medium I, and my heirs, hereby release Family Service Association of Redlands and any other people officially connected
with this event, from any and all liability for damage to or loss of personal property, sickness or injury from
whatever source, legal entanglements, imprisonment, death, or loss of money, which might occur while
participating in this event.
!Specifically, I release said persons from any liability or responsibility for my physical condition, for the condition
or selection of course route, and for the presence or actions of any other participants. I am aware of the risks of
participation, which include the possibility of sprained muscles and ligaments, broken bones and fatigue. I also
attest and verify that I am physically fit to participate in the Hunger Walk and take full responsibility if knowingly
push beyond my physical limits at any time during the event.
!I hereby authorize Family Service Association of Redlands to submit for publication or publish photographs taken
!
of my group and the names of participants, as applicable. Photos may be submitted to local newspapers, or be
published directly on FSA’s website and/or in our newsletter, email blasts and social media. Since our
participation in publications and online media produced by FSA is voluntary, no one represented in the photos
published will receive financial compensation. I further agree that our participation in any publication and
website produced by FSA confers upon us no rights of ownership whatsoever. I release FSA, its contractors and its
employees from liability for any claims by group members or any third party in connection with our participation. ParGcipants signature !
!
If under 18, parent or guardian’s signature Date Date
Family Service AssociaGon of Redlands, 612 Lawton Street, Redlands, CA 92374 Office 909 793-­‐2673 Fax 909 793-­‐7324 Website redlandsfamilyservice.org Email [email protected] Tax Payer ID 95-­‐1655614