2014 Niswonger Children’s Hospital Kids’ Run Community Grant Program Registration Form


  • Lead school representative is required to be present the day of the run to facilitate student registration and assist with head count for grant award determination.
  • Lead school representative may be a school administrator, teacher, Coordinated School Health Coordinator, PTO member or parent.
  • In order to be included in the head count for the community grant awards, children must be present the day of the Kids’ Run.
  • Lead school representative will provide appropriate W-9 documentation.
  • Lead school representative understands that any funds received from the Kids’ Run Community Grant Program, if eligible, will be used for nutrition or fitness-based programs within the school.
By signing below, each participant acknowledges that he/she is 18 years of age or older and has signature authority for the participating organization. In consideration of your acceptance of this entry, I/we waive and release East Tennessee State University and Mountain States Health Alliance from any and all claims and causes of action arising from any injury to the participants resulting from participation in the Niswonger Children’s Hospital Kids’ Run & Walk N’ Roll whether such injury is the result of negligence or some other cause. If any participant requires medical attention for any injury or illness, I/we give my permission for any necessary medical care and I/we assume all financial responsibility for such care. I/We also give permission for the sponsors to use any films, videos, and/or photographs of the participants (the “Images”) for publicity, educational, or other promotional purposes in printed publications, on television, on a sponsor website, or other similar media. The images may be used in whole, in part, or in composite form as combined with other images, with no restrictions as to image modifications.

Do you agree to the statement above?