WAIVER I know that participating in this walk/run is potentially hazardous. I should not enter unless I am medically able and properly trained. I also assume any and all risks associated with this event including but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, and the condition of the roads and traffic, all such risks being known and appreciated by me.
Knowing these facts, and in consideration of your accepting my entry, I hereby, for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, covenant not to sue, and waive, release and discharge Cornell Cooperative Extension of Jefferson County, sponsors, the town of Theresa, the State of New York, and/or any agents authorized by them for any purpose.
This release and waiver extends to all claims of every kind or nature, whatsoever, foreseen or unforeseen, known or unknown.
The event raises money for “Camperships” that enable financially stressed and disadvantaged youth to attend one week of residential youth camp at 4-H Camp Wabasso.
Cornell Cooperative Extension Association of Jefferson County is granted permission to use and/or publish my photograph or image (including audio, film, digital image or any other media) for educational programs or promotion of Extension programs, including 4-H Camp Wabasso.
_________________________________________ Name of Participant _________________________________________ Signature of Participant/Guardian _________________________________________ Date
Cornell Cooperative Extension of Jefferson County 203 North Hamilton Street Watertown, NY 13601
Applications for minors are accepted only with a parent / guardian signature.
Before June 12, campers collect pledges from neighbors, family, or friends. The camper who raises the most money is awarded a FREE one-week campership!
For Pledge Forms contact Cornell Cooperative Extension (see front of pamphlet) or forms can be printed from our website www.4hcampwabasso.com.
Sunday, June 12 at 4-H Camp Wabasso, just outside the Village of Redwood in the Town of Theresa, NY. 5k/10k events will start at 10:00 a.m.
1 Mile Hike - SUPERVISED
50% of the pledges will benefit the 4-H Camp Wabasso Scholarship Fund and the other 50% goes towards the individual's camper registration.
Race Day Age:_________
Pre-registration fee is $20 (guarantees t-shirt). Deadline June 8.
Pre-registration packet pickup is Sunday, June 12 from 8:30-9:30 a.m. at 4-H Camp Wabasso.
City/ Zip:____________________________________ Phone:__________________________________
Event Day registration fee is $25 from 8:30-9:30 a.m. at 4-H Camp Wabasso. (t-shirt not guaranteed).
Email:___________________________________ Circle T-shirt Size
Adult Size: S
Amount Paid: $_________BIB#_______________ Award Categories 19 and under 20-29 30-39
40-49 50-59 60 and over
Pre-registration forms must be received by June 8 to guarantee T-shirt and lunch. PLEASE sign and date WAIVER on back side. Thank you.