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Step Up For SIDS Registration Form
Print Form
Make Checks Payable To SIDS Network Of Kansas, Inc.

PLEASE PRINT CLEARLY
First Name - _________________________________________________


Last Name - _________________________________________________


Address - ___________________________________________________


State - __________    Zip - __________    Phone -__________________


E-Mail Address - _____________________________________________


Gender -  Male_______      Female_______     Age as of April 9th, 2005_______


T-Shirt Size - S_______  M_______  L_______  XL_______  XXL_______

Category -   Fun Stair_______   Competitive Stair_______  

Walk/Run Track_______   

Individual_______   Team_______

If Team -
Team Captain's Name - ________________________________________________


Preferred Team Name - ________________________________________________


I have been affected by SIDS - Yes_______   No_______

WAIVER: (Must be signed by participant.) Inconsideration of the agreement by Wichita State University Intercollegiate Athletic Association, Inc., a not-for-profit corporation, 1845 Fairmount, Wichita, Kansas, 67200-0018 (herinafter called "Owner") and the SIDS Network Of Kansas, Inc.,a not-for-profit corporation, 1148 Hillside, Suite 10, Wichita, Kansas 67211 (hereinafter called "SIDSNK")(collectively, the "Released Parties") to permit me to enter Cessna Stadium to participate in STEP UP FOR SIDS. I hereby for myself, heirs, executor, and administratiors, waive to the fullest extent permitted by law any and all claims I may have for damages against the Released Parties and all individuals associated with this event, their representatives, successors and assigns for any and all injuries suffered by me in connection with this event, included pre and post STEP UP FOR SIDS activities. I have been warned that I must be in good health to participate in this event and attest and verify that I am physically fit and have trained sufficiently for this event. I understand a temporary, non-harmful cough or chest stinging sensation may result after participating. I shall at all times comply with any special instructions given by Owners security guards or other officials of Owner and shall not intentionally interfere with the safe enjoyment of the event by the others participants. The foregoing shall in no way obligate Owner, SIDSNK or any other Released Pary to ensure my safety. I grant permission to SIDSNK to use my name and photographs, videotapes, motion pictures, recordings and any other record of my participation in this event for any purpose.


_______________________________________________________
Participant

_______________________________________________________
Participant's parent or guardian, if participant is under the age of 18