Registration To expedite the registration process, use the online form below. Alternatively, you can pick up a registration form at the State Police Office or print the downloadable waiver form. Fill it out and bring it to registration. Δ InstagramThis field is for validation purposes and should be left unchanged.All participants under 18 yrs. must have a parent/guardian signature to participate. An adult must accompany all children under 12 yrs. throughout the event.Adult ParticipantsAdult Participant 1(Required) First Name Last Name Shirt SizeNo ShirtSmallMediumLargeXL2X3XAdult Participant 2 First Name Last Name Shirt SizeNo ShirtSmallMediumLargeXL2X3XCell Phone(Required)Family Zip Code(Required)Child/Minor ParticipantsChild Participant 1 First Name Last Name Shirt SizeNo ShirtChild SmallChild MediumChild LargeSmallMediumLargeXL2X3XChild Participant 2 First Name Last Name Shirt SizeNo ShirtChild SmallChild MediumChild LargeSmallMediumLargeXL2X3XChild Participant 3 First Name Last Name Shirt SizeNo ShirtChild SmallChild MediumChild LargeSmallMediumLargeXL2X3XEmergency Contact InformationContact Name(Required) First Last Contact Phone(Required)DonationPlease consider donating to the cause. All proceeds will be going to Officer Hare’s daughters.Would you like to donate?(Required) Yes No Donation Amount(Required) Email(Required)We will deliver a receipt to this email address. Credit Card(Required) Cardholder Name Card Details Waiver of LiabilityIn consideration of being allowed by the New Mexico State police to participate in the 2nd annual Officer Justin Hare Anniversary Run/Walk, I hereby agree that: I agree to accept and abide by the rules and regulations of the Sponsors as established by theSponsors and to obey the directions of the Sponsor’s representatives. I assume all responsibility for any injuries that I may sustain in the pursuit of the above-describedEvent. I understand and acknowledge that the above-described Event may involve potentially dangerous situations. I do hereby waive, release, and forever discharge the Sponsors and the City of Tucumcari, its co-sponsors, officers, employees, agents, and servants from any and all liability arising out of orin connection with the above-described Event. For purposes of this agreement, liability means all claims, demands, losses, causes of action, suits, or judgments of any and every kind that I, my heirs, executors, administrators, or assignees may have against the Sponsors because of any death, personal injury, or illness, or because of any loss or damages to property that occurs during the above-described Event. In the event of any illness or injury, I hereby consent to whatever x-ray, examination, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care from a licensed physician and/or surgeon as deemed necessary for my safety and welfare. It is understood that the resulting expenses will be my responsibility. I understand that video production and/or photography may be conducted during theEvent. I grant full and irrevocable consent to the Sponsors and those acting under its permission or upon its authority, the unqualified right and permission to reproduce, copyright, publish or otherwise use my or my children’s/family’s photographic likenesses. This document contains a waiver of liability. Please read it carefully before signing.Waiver Acknowledgement(Required) I acknowledge that I have received, read, understood and agreed to the above and I voluntarily sign this Waiver of Liability on behalf of me and the children/minors I am supervising.(Required)Adult Participant/Parent/Guardian Name First Last Date of Signature(Required) MM slash DD slash YYYY Signature(Required)
