Register for Firecracker Run - East Moline - Job: Start/Finish Tear down

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

Please enter your information into the fields below. Required fields are marked with *.

*First Name:
*Last Name:
*Gender:	Male Female
*Date of Birth:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Postal Code:
Primary Phone:
Secondary Phone:
*Email:
*Confirm Email:
Shirt Size:	Youth Small Youth Medium Youth Large Women's XS Women's Small Women's Medium Women's Large Women's XL Women's XXL Extra Small Small Medium Large Extra Large XX Large

Assignment-specific Questions

1. *Emergency Contact Name

2. *Emergency Contact Phone Number

Alternate Job Preferences

Alternate Job Preference #1:

Course Course - Clocks Hospital Beds Medical / First Aid Packet Pickup Packet Pickup Packet Pickup Post Race Party - Soft drinks Post Race Party - Beer Post Race Party - ID check Post Race Party - FOOD Registration Registration Registration Sanitation Sanitation Start/Finish Set up Finish Line Set Up - Luis Finish Line - People Movers - Luis Results Kids Race/After party Post Race Party - ID check Post Race Party - ID check Water Stations

Alternate Job Preference #2:

Course Course - Clocks Hospital Beds Medical / First Aid Packet Pickup Packet Pickup Packet Pickup Post Race Party - Soft drinks Post Race Party - Beer Post Race Party - ID check Post Race Party - FOOD Registration Registration Registration Sanitation Sanitation Start/Finish Set up Finish Line Set Up - Luis Finish Line - People Movers - Luis Results Kids Race/After party Post Race Party - ID check Post Race Party - ID check Water Stations

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.

* I fully understand and accept all conditions in this waiver.

Please Sign Below

Your electronic signature is the online equivalent of your ink-on-paper signature, and can be provided by typing your name where indicated. The electronic signature will signify your understanding, acceptance, and authorization to accept the conditions of this legal document, including the following statements:

• I have read, have understood, and do accept the agreement above.
• I understand that this is a legal document with effects that I approve and authorize.
• The registrant is the person(s) whose name is submitted as the recipient of the goods and services provided as a result of this transaction.
• I am authorized to agree to the terms of this document on behalf of the registrant.
• If the registrant is under 18 years of age, incapacitated, or mentally challenged, I assert that I am the parent/legal guardian or otherwise authorized to execute a legally binding agreement on behalf of the registrant.

• *Signature:

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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.
Click here to print the agreement.