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Team Save the Children
United Airlines NYC Half 2015 Registration Form
CONTACT INFORMATION
NAME: _____________________________________________________________________________
Please use address that you would like your swag bag to be delivered to (no P.O. Boxes):
ADDRESS: __________________________________________________________________________
CITY: _________________________________
STATE: ______________
ZIP: ________________
COUNTRY: __________________________________________________________________________
HOME PHONE: ________________________________ CELL PHONE: ________________________
eMAIL: ______________________________________________________________
How did you hear about us? _____________________________________________________________
By checking this box you opt-in to receiving e-mail communications from Save the Children
T-SHIRT SIZE:
XS
S
M
L
XL
EMERGENCY CONTACT INFORMATION
In case of an emergency please contact: _________________________________________________
RELATIONSHIP: __________________________________________
PRIMARY PHONE NUMBER: ________________________________
Once your registration form has been submitted we will reach out to you with additional
information on finalizing your registration and starting your fundraising page.
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FUNDRAISING AGREEMENT & LIABILITY WAIVER
YOUR FUNDRAISING COMMITMENT: Team Save the Children United Airlines NYC Half 2015 a
fundraising effort for Save the Children Federation, Inc. (SCUS). You will receive a guaranteed race
entry for the 2015 United Airlines NYC Half as well as signature team amenities including access to
personalized training plans, fundraising support (including a personal online fundraising page), custom
tech tee and great swag to fashion on race day, from SCUS in exchange for your fundraising efforts.
SCUS has a limited number of guaranteed entries available for the 2015 United Airlines NYC Half
event. Those entries are awarded based upon the participant's ability to meet the minimum fundraising
requirement. By signing this form and joining SCUS 2015 United Airlines NYC Half Team Save the
Children group you are committing to raise at least $1,500. You agree to raise the full amount by race
th
day, March 15 , 2015 11:59PM EST. You understand that SCUS reserves the right to charge your
credit card, as entered on this form below, for any shortfall of your commitment as outlined
above.
Please know that we will help you every step of the way to reach your goal. These campaigns are built
on $100, $250, $500, and even $1000 donations. Your friends, family and coworkers will support you.
We will provide you with lots of suggestions and proven ways to reach your goal, but you must be willing
to do the work on your end to solicit donations.
CANCELLATION POLICY: You are responsible for raising the fundraising minimum, even if for any
reason, including injury or illness, you are unable to participate in the event. You must contact the
SCUS Endurance Program Manager, Maria Palestis ([email protected] or
[email protected]) as early as possible in writing, if you are not able to participate. In the
event that we are able to find another athlete to take your place, you will be released from your
fundraising commitment after you have either made a donation or collected donations of at least 10% of
the fundraising commitment ($150). However, due to our contractual agreement with United Airlines
NYC Half, we cannot accept cancellations for any reason after February 9, 2015. Any monies that have
been collected from you before you leave the team are nonrefundable.
EVENT REGISTRATION: SCUS will pay for your United Airlines NYC Half registration fee. You
st
will be notified as to the registration instructions no later than December 31 2015. Athletes will
be responsible for paying their own travel and hotel expenses. This allows SCUS to continue its
outstanding record of delivering nearly 90% of its SCUS budget toward providing immediate and lasting
change to children in the US and around the world.
OTHER: I agree to be responsive to SCUS Endurance Events staff with regard to my fundraising
progress or lack thereof, and will keep SCUS Endurance Events staff up to date with regard to any
change of address, email or phone contact information, and/or the credit card information provided
on the bottom of this form. Failure to make fundraising progress or to communicate with SCUS
Endurance Events staff will open the team member to the possibility of losing their spot on the team.
I hereby further grant permission to SCUS to use, or authorize others to use, any photographs,
videos, recordings, or any other record of my participation in the Event and as a member of SCUS
Team Save the Children for any legitimate purpose in perpetuity.
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LIABILITY WAIVER:
COMPLETE RELEASE OF LIABILITY AGREEMENT: I acknowledge that participating in a marathon,
half marathon, cycling event, triathlon or any other athletic event as a member of SCUS Team Save the
Children, including pre- event training and related team activities is a potentially hazardous activity. I
hereby agree not to participate unless I am medically able and properly trained. I agree to abide by
any decision of an Event official relative to my ability to safely complete the event. I am voluntarily
entering this Event and assume all risks associated with participation. I grant the Medical Director of
the Event and their designee access to my medical records and physicians, as well as other
information relating to medical care that may be administered to me as a result of my participation in
the athletic event.
Having read this Waiver and knowing these facts, and in consideration of my acceptance of this
application, I, for myself, my heirs, successors, assigns, legal representatives, and anyone entitled to
act on my behalf, waive and release Save the Children Federation, Inc., and its representatives and
successors, officers, directors, members, agents, and employees from all present and future claims and
liabilities of any kind, known or unknown, arising out of my participation as a member of SCUS Team
Save the Children even though that liability may arise out of ordinary negligence or fault.
I agree that if any portion of this Fundraising Agreement and Liability Waiver is found to be void or
unenforceable, the remaining portions shall remain in full force and effect.
I have read and understood the contents and legal ramifications of this Fundraising Agreement
and Liability Waiver, and understand the conditions of engaging the activity.
SIGNATURE:
DATE:
FULL NAME (Print):
CREDIT CARD NUMBER:

CREDIT CARD TYPE American ExpresV'iscover 0asterCard 9isa
EXPIRATION DATE:
Please return this form to Maria Palestis by email or mail.
Email: [email protected]
Mail: Attn: Maria Palestis
501 Kings Highway East, Suite 400
Fairfield, CT, 06825
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