KIDS SPORTS CHALLENGE FUNDRAISER REGISTRATION FORM

Child’s Name: ________________________________________________________________________

School:___________________________________________ Grade:____________

Child’s Limitations or Cautions ____________________________________________________

Parent/Guardian Information

Name: ________________________________________________________________________

Street Address: ________________________________________

City:______________________________ State:_______ Zip: ______________

Phone: _____________________________ Email:______________________________

NOTE: While at the event, all children are to be accompanied by a parent or guardian.

Registration Fee and Donations

$10 Registration Fee X _______Kid(s) = $______________ Total

¨ I would like to donate an additional amount of $______________

¨ My child will not be participating, but I would like to donate $______________

Make checks payable to Kre8tive Kids and mail to: Kre8tive Kids, Haiti Fundraiser

P.O. Box 93042

Phoenix, AZ 85070

AUTHORIZATIONS and RELEASE:

Photograph Permission: I give permission for Kre8tive Kids to use any pictures of my child taken at the fundraiser event for future promotional purposes.

Release from Liability: Recognizing that Kre8tive Kids will do its best to ensure a safe experience, I understand that accidents may occur from my child’s participation in the sports activities. I agree to assume these risks. By signing below, I release Kre8tive Kids, its employees, volunteers, independent contractors, directors and agents from all liability in case of accidental injury or illness to my child or to me as a result of participating in the sports activities and the fundraiser event.

I have read and understand the above and have completed this form to the best of my ability.

Signature of parent or legal guardian:

____________________________________________________ Date: ____________________

Visit www.kre8tivekids.com for more information