2004-02-09 Regular Meeting - Laserfiche WebLink

Browse Search

JOIN THE MOVEMENT BY: Starting the Texas Round -Up program. I hereby pledge that 1 will become more active in 2004 by participating in the Texas Round -Up. Signature Date Participating in the April 171 Celebration and I OK event at the State Capitol. (The Celebration Day is free, but there is a $10 entry fee for the noncompetitive I OK.) *All competitive participants please register on-line at www.texasroundup.org Please mail this form into the Texas Round -Up: 420W. Riverside Dr. Austin,TX 78704 Name: ❑ M ❑ F Date of Birth: Daytime Phone: Address: City: Email: State: Zip: For I OK Registrants Only: T -Shirt Size Age on 4/17/04 1 OK fee $1 O payable to Texas Round -Up mail to: WAIVER STATEMENT. Entry invalid if not signed. In consideration of the acceptance of this registration, I the undersigned assume full and complete responsibility for any injury I may incur or cause during my participation in the event or while I am on the premises of the event I hereby release, hold harmless, indemnify and covenant not to sue The Texas Round -Up, the sponsors, promoters, volunteers and all other persons and entities associated with the event/program or their agents or employees. I will not enter and participate unless I am in good health and proper physical condition to participate. I assume the risks associated with this event, including but not limited to vehicular traffic on the course, non -contact injuries, falls, contact with participants, alcohol consumption, the effects of weather including high heat and/or humidity, and the conditions of the road, all such risks being known and appreciat- ed by me. I also give permission for the free use of my name and picture in any broadcast, telecast written account or any other record of this event. Fees are non-refundable. By my signature below, and my parents/ guardian s if I am under age 18,1 acknowledge that I have read the above waiver of liability and assumption of risk and that I agree to its terms and conditions. Signature: X Date: Parent/Guardian Signature:X Date: Fun Ideas for Activity: I. Go for a walk during your lunch break. 2.Take the stairs instead of the elevator. 3. Park your car farther away than usual. 4.Walk the dog. 5. Stretch while watching television. 6.Take a friend with you to workout. Es D PROGRAM LOG WWW.TEXASROUNDUP.O Note: Please consult a physician before starting any exercise program.