2023 PNAAF 5K RUN REGISTRATION

Select your 5K Walk/Run Challenge Option*

Face to FaceVirtual

Name*

First NameLast Name

PNAA Region*

Eastern Region Chapter*

North Central Region Chapter*

South Central Region Chapter*

Western Region Chapter*

Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email Address*

example@example.com

Gender*

MaleFemale

Age*

Shirt Size*

WAIVER AND LIABILITY RELEASE FORM and PHOTO RELEASE

PLEASE READ CAREFULLY BEFORE SIGNING

I, {name} hereby consent that I am fully informed of the potential hazards and risks associated with the activity/ties I am about to participate, (5K Walk, Zumba) being held in Central Florida on July 17, 2023.The risk of harm include but are not limited to, minor or major injuries, exposure to uncontrolled temperature and weather, and permanent disability and death. I understand these risks, and do hereby waive, release, absolve, indemnify, and hold harmless PNAAF and PNACF, Inc., or any of its personnel, sponsors, officers, directors, advertisers, volunteers, participants, members, owners, or administrators of the premises in which the activity takes place, for any claim arising out of injury to the participants that may occur at any time during the mentioned activity that PNAAF and PNACF, Inc. organized.

I hereby expressly assume all risk of injury and damage and release the State of Florida, State Department of Transportation and any municipality through which this event passes, from all liability and claims of whatever nature or cause which may occur as a result of my participation in this 5 K Walk and Zumba.

I further acknowledge that “No person or entity shall have the right to bring an action against the State or municipality or any person employed by the State or municipality who was acting within the scope of his authority, for damages resulting from or in connection with the 5K Walk or Zumba.

In an emergency, I grant permission to PNAAF and PNACF, Inc. and its personnel, to have authority, at my expense, to authorize medical treatment. I declare to the best of my knowledge that I am in good physical condition and have no diseases or injuries that would be aggravated by my participation in activities related to the PNAAF and PNACF, Inc. 5K Walk and Zumba.

I hereby give PNAAF and PNACF the unrestricted right and permission to copyright and re-use, publish, and republish photographic portraits and pictures of me or pictures in which I may be included, in whole or in part, separately or in conjunction with other photographs, in any medium now or hereafter known, and for any purpose whatsoever, including but not limited to illustration, art, promotion, or advertising.

I have read and fully understand the above statements*

I agree.

Comments:

REFUND POLICY: I understand there are no refunds given for the 2023 PNAAF 5k Fun Run/Walk. I agree to the terms to payment.*

I agree.