5K Run/Walk FUNDRAISING Participant Registration

  • Please print legibly. One participant per form. All fields are required. Signature required. Please Note: This form is ONLY for those registering as a fundraising participant. For regular registration, return to the previous screen and choose Option#1.
  • By completing this form you are agreeing to participate in the 5K Run/Walk event as a Fundraising registrant. Fundraising participants seek sponsorship for their participation in the run/walk event and turn donations into Berkshire South to support our TONE and Youth Health & Wellness programs. Win incentive prizes based on the amount of funds raised. All registrants must provide or have received online a minimum of $30 sponsorship on the day of the event at check-in. Please contact our Fitness Department at 413-528-2810 ext. 35 or by email at sleonard@berkshiresouth.org for more information.
  • Release of all claims & promise not to sue: As a participant in this and any other program of the Berkshire South Regional Community Center, I recognize and acknowledge that there are certain risks and I agree to assume all such risks, including any damage resulting from physical injuries, loss of services or consortium, loss or damage to property, or any other loss I may sustain as a result of participating in any and all activities connected with or associated with such programs. In consideration of the Berkshire South Regional Community Center accepting my or my child’s registration, and with the intent to be legally bound, hereby, for myself, for my child, all heirs, executors, administrators, and assigns, do hereby forever release, waive and relinquish all claims I have or may have as a result of participating in this and all other programs of the Berkshire South Regional Community Center. Furthermore, I promise not to sue the Berkshire South Regional Community Center and agree to indemnify and hold harmless and defend the Berkshire South Regional Community Center and its officers, agents, servants, employees and insurers from any and all liabilities, claims, demands, actions or causes of action resulting from my or my child’s participation in this or any other programs of the Berkshire South Regional Community Center. By signing this form, I hereby acknowledge that all information contained herein is true and correct and that I may give up legal rights.
 

Signature of Acknowledgement