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Shark Attack Clean Up/Green Team
Saturday, May 12, 2012 (08:00 AM - 11:00 AM)

* Required fields

* First Name:
* Last Name:
* Address:
* City:
* State:
or * Province:
* Zip/Postal Code:
* Country:
* Gender	Female Male
* Date of Birth:
* Email :
* Home Phone:
Work Phone:
*T-shirt Size:
*Have you volunteered with Miles for Moffitt before?:
*Age on Race Day:
*Email address:
Indicate person(s) you wish to volunteer with:
What is your cell phone number?:
Comment (eg: who you'd like to work with, or, list second volunteer choice):

PLEASE READ AND AGREE TO WAIVER
WAIVER MUST BE SIGNED to participate I understand and agree that volunteering in this event is potentially hazardous, and that I should not volunteer unless I am medically able. In consideration of volunteering for Miles for Moffitt, I assume full and complete responsibility for any injury or accident which may occur while I am traveling to or from the event, during the event, or while I am on the premises of the event. I also am aware of and assume all risks associated with volunteering in this event, including but not limited to falls, contact with other volunteers and participants, effect of weather, traffic, and conditions of the road. I, for myself and my heirs and executors, hereby waive and indemnify, release, forever discharge and hold harmless Miles For Moffitt, Inc. and its affiliates, officers, directors and employee, as well as event organizers, sponsors, promoters, Active.com and each of their respective agents, representatives, successors and assigns, and all other persons associated with the event, from any and all liabilities, claims, actions, or damages that may arise in connection with or are related to my participation in this event whether caused by negligence, action or inaction of any of the above parties, or otherwise. I hereby grant the above-listed parties the absolute and irrevocable right and permission to photograph film, videotape, record and portray my name, voice, portrayal, and/or likeness in connection with the event and to use the results and proceeds thereof to use, broadcast, distribute, publish, or alter for any purpose, including but not limited to promotional material, website content, advertising and publicity. Parents MUST SIGN if volunteer is YOUNGER than 18. This is to certify that my child has permission to volunteer, is in good physical condition and that event officials may authorize necessary emergency treatment.

INFO FOR PARENT/GUARDIAN COMPLETING THIS REGISTRATION
Registration for minors must be completed by a Parent or Legal Guardian. If your age on race day is less than 18 years old, please fill in the Parent/Guardian Contact Information below. Providing such information and continuing this process indicates that this registration was completed by the person listed below.
Parent/Guardian Name:
Contact Phone:
Contact Relationship:

*Agree to waiver:	I agree I do not agree