Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
What role(s) are you interested in?
Monthly Event Help (set up, tear down, assist)
Rekindled Nurse Conference (registration, set up, tear down, parking, volunteer at event, vendor table, speaker service, etc)
Crisis Support (making meals, sending cards/flowers to nurses in need, drop off, etc)
5K Run to Revive Fundraiser (parking, water station, registration, set up/tear down, raffle table monitor, aid station, run sweeper, etc)
Monthly Peer Groups (meals)
How did you hear about us?
Social Media
Falcon Website
Friend
Email Subscriber
Checkbox
*
WAIVER —– By my signature, I certify that I am medically able to perform this event, and am in good health, and I am properly trained. I agree to abide by any decision of an official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I attest that I have read the rules and agree to abide by them. I assume all risks associated with participating in this event, including but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, all such risks being known and appreciated by me. I understand that alcohol, bicycles, skateboards, roller skates or roller blades, and animals are not allowed at events and I will abide by all race rules. Having read this waiver and knowing these facts and inconsideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Rekindled Nurse, the venue, all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record of this event for any legitimate purpose.
I agree to the terms and conditions listed above