Simple Event Registration Form

2018 PHILADELPHIA GAMES REGISTRATION FORM

PLEASE FILL OUT ALL FIELDS WITH MOST RECENT INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Age*
Date of Birth*

MonthDayYear
Gender*

MaleFemale

LIABILITY AND PHOTO WAIVER
In consideration of my entry being accepted into the Philadelphia Games for Adults 50+, I, on behalf of my heirs, executors, administrators, and assignees release, indemnify, and hold harmless the City of Philadelphia, and the Philadelphia Games for Adults 50+ sponsors and co-sponsors from any and all injuries suffered by me as a result of my participation in the Philadelphia Games for Adults 50+.

To the best of my knowledge, information and belief, I have no physical restrictions that would prohibit me from participating in the events that I have selected. I hereby authorize, at my expense, any first aid or medical treatment deemed necessary for my health, welfare and safety.

I certify that I have sufficiently trained for each event that I have selected, and my good physical condition has been verified by a licensed physician in the past six months. I give permission for my photograph to be used by the
Philadelphia Games for Adults 50+ for advertising, promotional efforts, publicity and other legal purposes. I waive all claims for compensation or damages in
connection with such use.
Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number

PAYMENT & PROCESSING
My Products*
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Philadelphia Games Registration$20.00

Total $0.00
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