DCPReg

home   

 

 
Checks Payable to: The Detroit College Promise Run
 & mail this form to: 30100 Telegraph Rd , Suite 408, Bingham Farms, MI 48025

Event: (circle one) 5K Run    5K Non-Competitive Walk

Name:______________________________________ DOB:_________ Sex: M F

Address:__________________________City:____________State___ZIP: _______

Email:_____________________________________ Phone: ( )_______________

T-shirt:  Youth: M  L    Adult: S  M  L  X  XX

WAIVER In consideration of my acceptance of my entry, I for myself, my executors, administrators, and attendees do hereby do release and discharge The Detroit

College Promise, all sponsors, organizers, supporters, and spectators for all claims, damages, demands, actions, whatsoever in any manner arising from my participation

in said event. I test and verify that I have full knowledge of the risks involved in this event. I am physically fit and have my personal physician’s approval to participate.

Further, I hereby grant full permission to any and all of the foregoing to use my photograph, videotape, motion picture, or record of my participation in this event.

X_______________________________________________________________ Date____________________________

Signature of participant or parent/guardian if under 18 years of age

Comments