The Dutch Neck PTA would like to invite you to a friends and family event dedicated to health and fitness including a fun run for kids, healthy food options and a chance to learn about health, nutrition and fitness from local organizations. There is $5 registration fee for every Dutch Neck student, who gets to run with one family member or friend. Last day to register is September 30th, 2019. *Please note if you have two Dutch Neck students they would need to register separately. This fee is non-refundable.

Dutch neck student name *

Student’s grade and teacher *

Who is running with student?

Name of participating family member or friend *

Running category *

I agree - as the parent or legal guardian of the child/children named above, i hereby give my full consent and approval for my child or children who are registered here to participate in the dexter's fun, food and fitness block party. in addition to giving my full consent for my child's participation, i also hereby waive, release, hold harmless and forever discharge dutch neck pta, coordinators, officials, staff, volunteers, sponsors, supervisors, and representatives for any injury that may be suffered by my child in participation in the designated sports and activities incidental thereto, whether paid damages, injury, or loss due to negligence or not. i further agree to indemnify and hold the west windsor – plainsboro board of education and its agents and employees harmless from any and all liability, claims and/or litigation or other actions that i may have for injuries of any kind, including but not limited to direct, special, incidental, indirect, punitive, or consequential damages, whether arising in tort, contract or arising out of use or my requested use of the board property, facilities, staff, equipment, and/or services as noted above, even if caused by the negligence or fault of the board, any related entities or other authorized agents, including independent contractors. *

I consent and agree , that dutch neck pta volunteers may take photographs or digital recordings of my child as participant during this event which will be used only for event updates on the dutch neck pta social media and in the school yearbook. i waive any rights, claims or interest and i understand that there will be no financial or other remuneration. i certify that the child and accompanying members listed here are physically fit and have not been advised to refrain from participation in sports or other activities by a medical professional. i certify that there are no health-related reasons or problems which preclude my child/children’s participation in dexter's fun, food and fitness block party. *

I understand, the food sold at dexter's fun, food and fitness block party is not free of allergens. so it is at my own risk that i or my child/ren consume the foods sold. neither the pta nor the west windsor – plainsboro board of education is responsible for any allergic reactions. *

Signed by (please print your name) *

Phone *

Email *