SLCUT walk/run registration August 26th

SlcUT Walk/Run registration

Prime Inc SLCUT Fun Walk/Run Registration form

Fill out this form so that the Prime associates know how many to expect at the Prime fun walk/run on August 26th at 10:00am. Expect to walk, crawl, or skip a quarter mile course on the Prime Salt Lake City campus and get some swag for your efforts! The event will start at the yard entrance.

Name(Required)

First Last

Driver/User Code

Which are you?

Driver

In-house

Are you bringing anyone else to the event like a spouse or kids?

Yes

How many others are you bringing with you?

Emergency contact

Name

First Last

Phone

Waiver & Release

I confirm that I am in good shape, health, and condition. I don't have any medical condition or medical history that will affect my participation in this event. I acknowledge that this event requires physical activity and there are possible risks and danger. I release Prime Inc for any responsibility in case of an accident, illness, or injury. I grant Prime Inc permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I HAVE READ AND UNDERSTAND THE ABOVE WAIVER & RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW.

Signature(Required)