Journey Home Inc.

10th Anniversary Walkathon (2.7 miles)

Saturday, May 16, 2009 at 11:00am

Parking and Registration (10:30 am)at Hope Lutheran Church 1301 Vintage Lane, 14621

Registration and Contribution Tracking Form

Walk Participant Name__________________________________

Address____________________________________________________

City_____________________________State_________Zip_________

Phone Number__h__w___________________ E-mail

Address___________________

Money will be Collected Day of the Event. Checks are Preferred.

Please Make Checks payable to Journey Home, Inc.  Thank You!

Sponsor s Name

Address/City/State

Phone

Amount

Check

Cash

Total Amount Collected All Pages: ____________

Assumption of Risk, Release and Permission

In consideration of being allowed to participate in Journey Home, Inc. s Walkathon, I hereby expressly assume all risks of personal injury, death or

property loss arising in any way out of my participation. I represent that I am physically fit and able to participate in this event. I hereby release and

agree not to sue Journey Home, Inc., its officers, directors, volunteers, employees, sponsors, and agents, from or in connection with any and all

liability and claims arising out of my participation in this event. I grant full permission to the organizers of this event to use and publish my name and

image as a participant in photographs, video or other recordings.

Signature_________________________________________________________________________

Date_______________

If Participant is a minor or acts in accordance with a legal guardian, the parent or guardian must sign and agree to the below:

I am the parent and/or legal guardian of Participant, and I herby consent to his/her paricpatio. I have read the foregoing agreement, and I herby

agree on behalf of myself and Participant to its terms.

Additional forms available at journeyhomegreece.org