WALK TO  THE BEAT   FOR CHD May 21, 2005 North Haven Town Green Registration: 8:30 am Walk: 10:00 am Rain or Shine! Name: (please print) __________________________   M ___ F___ Address: _______________________ City, State, Zip Code: _______________________________ Age on race day: ____ e-mail:____________ (if applicable) Child’s name: ____________________________   M __   F ___ Age on race day: ____ Child’s name: ____________________________   M __   F ___ Age on race day: ____ Child’s name: ____________________________   M __   F ___ Age on race day: ____ For walkers who raise $100.00 or more:, t-shirt size: S M L XL   Waiver and Release of Liability – In consideration for joining the WALK TO THE BEAT FOR CHD, I hereby assume any and all risks which may be associated with my participation in the Walk To The Beat For CHD Walkathon. I further waive all claims against the CHDA, Inc. and the town of North Haven, its officers, directors, volunteers, agents and assigns, from any and all injuries or liabilities which might occur in the Walk. I grant full permission for the organization to use photographs of me taken at the Walk and any accompanying events. Print Name: _________________________________________      Signature: ________________________________________     Date: _______________ Parents permission/ signature if under 18 years of age: ___________________________________________________________     Date: _______________