4th Annual Tie One On for Prostate and Colon Cancer Awareness Fundraiser

1 Stadium Dr,Chester PA 19013

18 June, 2022

Description

Our mission is to bring awareness in the battle against Prostate and Colon Cancer in our annual Walk, Run, and Ride Event. Come join us for our 4th Annual Prostsate and Colon Cancer Awareness Fundraiser. This family-orientated fundraiser will be held on Father's Day weekend, Saturday, June 18, 2022 at the Subaru Park Stadium in Chester, PA. Participants will Walk 2 miles, Run 5 miles, or Ride their bikes for 15, 25 or 40 miles and take part in other fun amd healthy activities. Former and current prostate and colon cancer patients, their families and the public are invited to take part in this event, ranging from young children to people in their seventies. Their will be healthy snack, drinks, warm-up sessions before each event and all participants wil recive t-shirts and gift bags. Prosstate and Colon Cancer affect so many people in our community and thids fundraiser is a great way to help fight this terrible disease and spread awareness. So Come out and Join us on Saturday, June 18th to Walk, Run or Ride!!! PLEASE COMPLETE THE INFORMATION ON THIS FORM REGISTRATION FORM Name: __________________________________________ Member: Yes or No Local# ___________ Address: ______________________________________________________________________________________ City: __________________________________________ State: ____________ Zip Code: _______________ Phone: __________________________________________ Email Address: ______________________________________________________________________________________ Male: ________ Female: _________ Age: _______ Emergency Contact: _____________________________________ Contact Number: ____________________ Survivor: __________ Sponsor: ___________ T-Shirt Size: please check one: Small: ____ Medium: ____Large: _____XL: _____1X: _____2X: _____3X: _____Other: _____ Registration: Check one Day of Event Registration Times _____ 2 Mile Walkers: $25 ($20 before 6/1) Walkers 8:00 am _____ 5 Mile Runners: $35 ($30 on 6/1) Runners 7:30 am _____ 5, 15, 25 or 40 Mile Bikers: $50 ($45 on 6/1) Bikers 7:00 am Event: 2 Mile Walk: ______ $25 5 Mile Run: _______ $35 5, 15, 25 or 40 Mile Ride: ______ $50 Signature: ____________________________________ Date: ____________ PLEASE COMPLETE THIS INFORMATION FORM Release and Waiver of Liability Form Name: _____________________________________________ Date of Birth: _______________________ Email Address: ________________________________________________________________________________ Name of Deceased Loved One: ____________________________________________________________ This agreement is by and between Laborers’ Local Union 413 and the undersigned individual. 1. _____The undersigned individual, hereby agree that I am participating in the Tie One On for Prostate & Colon Cancer Awareness Fundraiser and acknowledge that this activity may cause physical injury and that I am fully aware of the risks involved and agree to hold harmless the Parties for any such present or future injury that may occur, related to this event. 2. _____I warrant that I have no physical/medical conditions that would prevent my participation in the physical activity. 3. _____I knowingly, voluntarily and expressly waive any and all claims that I may have for damages and injuries of every nature which occur as a result of my participation in the Tie One On for Prostate & Colon Cancer Awareness Fundraiser. 4. _____By signing this waiver it is my intent to forever discharge and release Parties and it board members, from any and all liability for any and all injuries that may be sustained by me as a result of my participation in the Tie One On for Prostate & Colon Cancer Awareness Fundraiser are not responsible for loss of material, supplies, equipment, personal belongings, etc. 5. _____All cyclist are required to wear a helmet and Obey All Traffic Laws!! (NO EXCEPTIONS). 6. _____I understand that this waiver shall be binding upon my heirs, assigns and legal representatives. I have read the above Release and Waiver of Liability and fully understand the contents thereof and voluntarily agree to the terms outlined herein. I am volunteering as a participant in the Parties, Tie On for Prostate & Colon Cancer Awareness Fundraiser and I do hereby release unconditionally and forever, and indemnify and hold harmless the Parties, its directors, board members, sponsors, staff, employees and servants from any and all claims of damages directly or indirectly resulting from my participation in this Tie One On for Prostate & Colon Cancer Awareness Fundraiser, coordinated by Parties. __________________________________________________________ Print Name ____________________________________ __________ ___________________________________ ____________ Participant’s Signature Date Parent’s Signature Date (For participants under 18) Laborers’ Local Union 413 222 Penn Street Chester, PA 19103 BIKE RIDE registration starts at 7:00am.... Ride starts at 7:30am.......... 5,15, 25 & 40 miles! RUNNERS registration starts at 7:30am.... Run starts at 8:00am.....5 miles! WALKERS registration starts at 8:00am.... Walk starts at 8:30am....2 miles!