Your registration for the 5K Race, Pahokee Florida

Registration Fees
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Date of Birth
Phone Number
Emergency Contact Name
Emergency Contact Phone Number
Team Leader's Name
Team Name
The Smiles and Vision Foundation’s disclaimer:

5k Run and Walk, Waiver & Release Form

I acknowledge that my participation in the 5k Fun Run and Walk involves a risk of injury, including bodily injury, and assume the risk for the same. On my own behalf and on behalf of my heirs and legal representatives and to the fullest extent permitted by law, I hereby release and discharge the Smiles and Vision Foundation and their respective directors, officers, employees, affiliates, members, agents and representatives, of and from any and all liability for injury, death, or damages and/or any other claims, demands, losses or damages, incurred by me in connection with any aspect of the 5k run and walk.

If I am an employee of Clear Vue Laser Eye Center, I acknowledge that my participation in the 5K Fun Run and Walk is completely voluntary and does not constitute part of my work-related duties. I understand that my decision to participate, or not participate, in this activity will not affect my job status.

eSignature of Parent

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