Walk This Way Registration

Thank you for participating in our 2014 Walk This Way program. Please provide us with the information listed below and we will prepare a Walk This Way “passport” for you. You can pick up your passport at the first walk you attend.

The passport you will receive contains all the scheduled walks and an area where walk coordinators can mark off walks you participate in. If you take part in 5 or more walks, you will be eligible for the “Grand Prize Drawing” at the end of the program in May.

Register for Walk this Way

Name:
Mailing address:
City, State, Zip:
E-mail address:
Age range:
Phone:
Gender:
Have you ever participated in this program before?: Yes No
How did you find out about Walk This Way:

Your information will only be used for tracking your participation in Walk This Way. We will not sell or distribute your information to anyone for marketing purposes. Occasionally, group pictures will be taken during the walks for promotional purposes. If that is a concern to you please see the walk officials when you check in the day of walk.

We will send you weekly email with reminders of upcoming walks and any walk location changes or cancellation due to the weather.

Please read and agree to the Release and Indemnification form below.

Release and Indemnification- Walk This Way
Fargo Cass Public Health, affiliated event host and sponsors

The Fargo-area Walk This Way Events, a 2-month campaign, involves 15 sponsored group walking events. These events will involve walking and engage citizens in the benefits of walking and physical activity and raise awareness about the importance of creating a walkable community. In consideration of being allowed to participate in this event, I hereby expressly assume all risks, including personal injury and death, arising out of my participation in the Walk This Way event and related activities. As a participant in Walk This Way, I understand that it would be in my best interest to have my personal physician conduct a check up to ensure that I can fully participate in the Walk This Way walks.

It is my responsibility to determine changes appropriate for my health, well-being and lifestyle. Although snacks and refreshments may be provided at the events, and other assistance may be made available during these activities, I am solely responsible for my own health and safety. I represent and warrant that I am physically fit and able to participate in Walk This Way. Should I experience discomfort during any physical activity that I engage in, I agree to discontinue and request assistance.

In consideration of my participation, I agree, for myself, my heirs, executors and administrators, to not sue and to release, indemnify and hold harmless, Fargo Cass Public Health, its affiliates, officers, directors, volunteers and employees and all sponsoring businesses and organizations and their agents and employees, from any and all liability, claims, demands, and causes of action whatsoever, arising out of my participation in this event and related activities -- whether it results from the negligence of any of the above or from any other cause.

The foregoing release and indemnification agreement shall be as broad and inclusive as is permitted by the State of North Dakota. If any portion of it is held invalid, the remaining provisions shall continue in full force and effect.

By checking this box you agree to the following statement: I have read and understand the foregoing release and indemnification agreement, and I hereby agree to the terms of this Agreement.

By checking this box you agree to the following statement: I am the legal guardian of Participant, and I hereby consent to his/her participation. I have read and understand the foregoing release and indemnification agreement, and I hereby agree on behalf of myself and Participant to its terms.