weerace registration form

WeeRace Kids 1 Mile Fun Run & Roll

Athlete’s Name *
Athlete’s Name
Athlete’s sex *
Parent/Guardian’s Name *
Parent/Guardian’s Name
Parent/Guardian’s Phone
Parent/Guardian’s Phone
Day of Race Contact *
Day of Race Contact
Day of Race Contact *
Day of Race Contact
T-Shirt Size *
Level of Assistance Needed *
Buddy will have to register as VOLUNTEER and select you as a Buddy. An email will be sent “friend has requested you as Buddy" with a link to volunteer registration
Equipment my Child will be bringing to the event *
In consideration of your accepting this entry, I, intending to be legally bound, for myself, my heirs, my executors and administrators, waive and release and any all rights and claims for damages I may have against the race, and sponsors and their representatives, successors and assigns for any and all injuries suffered by me in said event. I attest that I will participate in this event as a footrace, that I am physically fit and sufficiently trained for the completion of this event.
I hereby grant full permission to any and all of the foregoing to use my/my child’s photograph/likeness/voice, as it pertains to my participation in the WeeRace Kids 1 Mile Fun Run & Roll, in any manner for promotional efforts without expectation of or right to any reimbursement in connection with its use.
Have questions, please contact Julie Kwasiborski at julie@therapeuticlinks.com or (847) 548-3458 ext #2
Proceeds from this event will go to WeeBits, a local non-profit organization providing awareness and guidance to those families with infants/toddlers who are "at-risk" and may fall outside the boundaries of existing child developmental programs. WeeBits provides FREE enrichment classes and workshops for families and caregivers to help them understand how to help their child. Our goal is to raise $575 to offer 2 classes and 2 parent workshops to families with Warren Special Recreation Association in Gurnee in Fall 2017.
Additional information available and donations may be made to WeeBits at www.weebitsforfamilies.org