Water Stop
Sunday, June 2, 2013 (08:00 AM - 12:00 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:
*T-shirt Size:
Comment (eg: who you'd like to work with, or, list second volunteer choice):

PLEASE READ AND AGREE TO WAIVER
By volunteering for this event, you are acknowledging the following: In consideration of being accepted as a volunteer for this event, I, for my heirs, personal representatives and assigns waive and release any and all claims I may have as a result of my volunteering for the Dynamic Dirt Challenge against the organizers and sponsors, including, but not limited to sheJAMs LLC. I further state that I am physically fit to undertake the tasks I have selected or been assigned. By volunteering for the Dynamic Dirt Challenge you grant sheJAMs LLC unconditional permission to use photographs, video and quotations on its website, in brochures or any other foundation related activity.

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