Site Breakdown
Saturday, May 12, 2012 (12:00 PM - 04:00 PM)

* 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:
cell phone #:
Are you a breast cancer survivor?:
Comment (eg: who you'd like to work with, or, list second volunteer choice):

PLEASE READ AND AGREE TO WAIVER
I wish to volunteer for the CT BREAST HEALTH INITIATIVE, INC. I understand that the nature of volunteer activities that may be performed for the 2012 RACE IN THE PARK and during CT BREAST HEALTH INITIATIVE, INC. events may involve physical activity, contact with unidentified and/or unfamiliar persons, or other potential risk of personal injury or accident. Knowing this and in consideration of being allowed to volunteer, I hereby assume full and complete responsibility for any injury or accident which may occur during my participation as a volunteer. In addition, I hereby release, indemnify and hold harmless the said CT BREAST HEALTH INITIATIVE, INC., 2012 RACE IN THE PARK committee members and any of their partners, agents, sponsors, board members, successors and The Hartford Marathon Foundation from any and all liability claims, judgments or responsibility for any such accident or injury. (Must be signed by a parent if volunteer is under 18 years of age.)

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