REGISTRATION FORM PDJ Kiskeya
Registration is free please submit by
Name: ____________________________________
Address: __________________________________
City: ______________Postal Code: ___________
Phone: ( ) _______________
Special Health needs _____________________________
Date of Birth: _______________ (dd/mm/yyyy)
Email: _____________________________________
Emergency Contact:
Name: ___________________________________
Phone: ( ) ______________________
I, as a participant of the Kiskeya PDJ Run
, accept full responsibility of any risks,
Liabilities or injuries that may occur to me.
Kiskeya PDJ and its organizers
Cannot be held accountable. Nor will any attempts be made by me to seek any type of compensation from Kikskeya PDJ and or organizations, staff and or coordinators of Kiskeya PDJ Route of the Red Tail Hawk. In the event of any injury and or adverse occurrence to my person as a participant in Kiskeya run.
I the undersign clearly understands and have been informed that Kiskeya 2011 PDJ PDJ staff coordinators and organizations connected to are not responsible for
Anybody who voluntarily participates in PDJ Kiskeya Run as stated above as well I’m responsible
For the cost of all my necessary expenses and international documents of Identification as well as abiding by the laws of country and or countries where PDJ runs are held...
_______________________________________
Participants Signature
________________________________________
Parental/Legal Guardian Signature (if under 18 yrs)
Photo Release
By Signing the form, I ________________________ (name)
Give PDJ Caribbean Region Route of the Red Tail Hawk
Permission to use photos taken of my child at
In their publications and/or websites
And/or videos. I understand that my child’s name may,
In some cases, be used with the picture. I understand
That I will not be compensated for such photo use. I
Give my full permission for such photos to be used
both now and in the future.
____________________________________
(Name of participant)
____________________________________
(Parent/Legal Guardian Signature)