SvDP Walk Registration

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Corpus Christi Society of St. Vincent de Paul
Corpus Christi Parish
6300 McKenna Drive
Mobile, AL 36608
251-342-1852

Walk Coordinators: Ann Mackie & Danny Kelly

Please enter the following information for the primary contact person for this registration form and then complete the registration for each participant.
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Street Address REQUIRED Please fill out this field. Please enter valid data.
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Zip REQUIRED Please fill out this field. Please enter a zip code.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Number of Participants REQUIRED Please fill out this field.
- Participant 1
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Email REQUIRED Please fill out this field. Please enter an email address.
  - Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - T-Shirt Size REQUIRED Youth Large Youth XL Adult Small Adult Medium Adult Large Adult XL Adult 2XL Adult 3XL Please fill out this field.
- Participant 2
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Email REQUIRED Please fill out this field. Please enter an email address.
  - Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - T-Shirt Size REQUIRED Youth Large Youth XL Adult Small Adult Medium Adult Large Adult XL Adult 2XL Adult 3XL Please fill out this field.
- Participant 3
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Email REQUIRED Please fill out this field. Please enter an email address.
  - Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - T-Shirt Size REQUIRED Youth Large Youth XL Adult Small Adult Medium Adult Large Adult XL Adult 2XL Adult 3XL Please fill out this field.
- Participant 4
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Email REQUIRED Please fill out this field. Please enter an email address.
  - Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - T-Shirt Size REQUIRED Youth Large Youth XL Adult Small Adult Medium Adult Large Adult XL Adult 2XL Adult 3XL Please fill out this field.
Accident Waiver and Release of Liability
I recognize and acknowledge that there are inherent risks in my presence and participation in the St. Vincent de Paul Friends of the Poor® Walk/Run on the date of the walk I am registered for. I acknowledge that this Accident Waiver and Release of Liability form will be used by the event holders, sponsors and organizers, in which I may participate, and that it will govern my actions and responsibilities at said events. In consideration of my registration and participation in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns as follows:

(A) I hereby expressly agree that the Society of St. Vincent de Paul, its directors, officers, employees, volunteers, representatives and agents, event holders, event sponsors and event directors (all hereinafter referred to as St. Vincent de Paul) shall not be liable for any damages arising from personal and/or bodily injury, including death or property damage sustained by me or my guest while participating in the Friends of the Poor® Walk/Run. I assume full responsibility for any such injuries or damages that may occur to me or my guest. I also specifically agree that St. Vincent de Paul shall not be responsible for any such injuries, loss or damage even in the event of negligence or fault by St. Vincent de Paul. This waiver does not, however, apply to gross negligence or intentional torts by St. Vincent de Paul.

(B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals and entities as a result of any of my actions during this event. I am aware the Society of St. Vincent de Paul does not provide health and accident coverage for me and it is my responsibility to pay any medical bills from injuries sustained while participating in the Friends of the Poor® Walk/Run.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during this event. I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors organizations and assigns.
I have read and fully understand this waiver and release of claim form. By checking below I am consenting to these terms.
I Agree Please select this field.
Waiver for Minors Participating (under age 18)
The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all the parties referred to above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian. I understand that the foregoing Accident and Release of Liability shall apply to my child. I hereby give permission for my child to participate in the Friends of the Poor® Walk/Run, with the understanding that every reasonable
effort will be made to plan for safe participation in this event.
I Agree Please select this field.
I would like to make a donation to the Society of St. Vincent de Paul along with my registration for the walk.
Enter the amount of your desired donation.
$ Please enter a positive decimal.

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SvDP Walk Registration

Corpus Christi Society of St. Vincent de Paul

Accident Waiver and Release of Liability

Waiver for Minors Participating (under age 18)