Please complete the registration form below to be considered as a volunteer for this event.
You will receive a confirmation email if you are assigned as a volunteer.
Registration Information
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Required fields are marked with *.
Assignment-specific Questions
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*Emergency Contact Name
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*Emergency Contact Phone Number
Alternate Job Preferences
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Registration Waiver
In consideration of the acceptance of this entry, I knowingly recognize the risks involved in the running of a road race, and I hereby waive and release any and all claims for this event against the Firecracker Run, the City of East Moline, IL, and all Sponsors of this event, or any employees, volunteer official or elected official of these organizations for said injuries. I also assume any and all other risks associated with running in this event, including but not limited to falls, contact with other participants, the effects of weather, etc. I certify that I am physically fit and have sufficiently trained so as to participate in this event. If, during my participation in this event, I require medical attention, I hereby give my consent to authorize the medical personnel of this event to provide such medical care as is deemed necessary by such individuals.
This Release and Waiver is binding upon myself, my heirs, executors, administrators or anyone else who might claim on my behalf. This Release and Waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown.
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You are encouraged to keep a copy of this agreement for your records.
This agreement was generated at 8:53:28 AM EDT on 4/25/2018.
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