Volunteer Registration Personal Information First Name * Please provide your first name. Last Name * Please provide your last name. Address * Please provide your address. City * Please provide your city. State * Please provide your state. Zip Code * Please provide your zip code. Phone * Please provide your phone number. Email * Please provide a valid email address. Date of Birth * Please provide your date of birth. Sex * Male Female LGBTQ+ Do you speak any language other than English? Occupation Volunteer Skills Emergency Contact Emergency Contact Name * Please provide an emergency contact name. Emergency Contact Phone * Please provide an emergency contact phone number. Waiver I know that participating in Shifting Gears United athletic events is potentially hazardous. I agree not to enter any Shifting Gears United race, activity, or sponsored event unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the activity. I assume all risks associated with participating, including, but not limited to: falls, contact with vehicles, other participants, spectators, or others, the effect of the weather, including high heat, extreme cold and/ or humidity, traffic conditions of the road, all such risks being known and appreciated by me. I understand that (1) participation with Shifting Ge ar s Uni t ed is strictly voluntary, and (2) I amonly to receive/provide running companionship, advice, and encouragement from my fellow Shifting Gears United athletes/volunteers/guides. If anything, else is asked of me, or if I am otherwise uncomfortable or concerned, I will bring it to the immediate attention of the Shifting Gears United President Initial Here (to acknowledge you have read this section) * Please initial this waiver section. Waiver Having read this Waiver and knowing these facts, and in consideration of your accepting my application, I, for myself or for my child and anyone else entitled to act on my behalf, waive and release, and agree to indemnify and hold harmless Shifting Gears United to which I belong (including directors, officers, leaders, members, athletes, volunteers, guides), the local county and city departments of Parks and Recreation, all sponsors of Shifting Gears United and any of their races or events, m e m b e r s and volunteers, from present and future claims and liabilities of any kind, known or unknown, arising out of my participation in any Shifting Gears United event or related activities, even though that liability may arise out of ordinary negligence or fault on the part of the persons named in this Waiver. By registering for a Shifting Gears United or any other race though Shifting Gears United, I hereby grant my permission to Shifting Gears United to act as proxy on my behalf for that race with full authorization to execute consents, waivers and releases included in the Shifting Gears United registration. I further grant my permission to all the foregoing to use photographs, motion pictures, recordings, or any other record of my participation in Shifting Gears United for any legitimate purpose, without remuneration. I have read this waiver and agree to the terms. Signature Print Name * Please print your name. Signature (Type your full name) * Please sign by typing your full name. Date * Please provide the date. I am unable to consent (under 18 or other reason) I am unable to read Parent/Guardian Information Required for volunteers under 18 years of age or unable to consent. Guardian Print Name Guardian Signature (Type your full name) Date Witness Information Required if participant is unable to read. Witness Print Name Witness Signature (Type your full name) Date Submit Registration
