Family Services of the Merrimack Valley Logo

Saturday, October 19, 2024
9:00 a.m. - 11:00 a.m. 
Andover High School Field House
80 Shawsheen Road, Andover, MA

Register Walkers
$40 • 4 Walkers Per Registration Form
$40 each (click on + sign for number of walkers registering)

**Children 12 and under do not need to pay and do not get a t-shirt.

$

Your support will be attributed to:

T-shirts no longer available

INHERENT AND POTENTIAL RISKS:  I, as evidenced by my registration to participate in the Samaritans of Merrimack Valley 8th Annual Walk for Hope on October 19, 2024  in Andover, MA for myself, my executor, my personal representative, administrator, heirs, devisees and assigns, understand that during the Walk, I will be using public streets and other public and private facilities including the Andover High school  grounds where many hazards exist and I am aware of and appreciate the risks that may result.  I am also aware that accidents may occur during the Walk that could result in serious injury or death.  My participation in the Walk is voluntary with knowledge of all such risks.  I do hereby discharge the Samaritans of  Merrimack Valley and its parent organization, Family Services of the Merrimack Valley, Andover High school, the event site, their management, their officers, board members, employees, members, sponsors, volunteers, organizers or their representatives, or their successors and all cooperating businesses and organizations from all claims of damages, demands, actions, illnesses, death and causes whatsoever in any matter arising from or growing out of my participation or that of my child in the event.

 

MEDICAL EVALUATION:  I attest and verify that I am, or my child or children (under 18), are medically able to participate and assume all risks of participation in this event.  I state that I am physically fit and able to walk the approximate 3 mile Walk route of the Samaritans 8th Annual Walk for Hope.  If I am under the age of 18, my parent(s) have consented to my participation at the Walk.  This Waiver extends to any liability arising out of or in any way connected with the medical treatment, assistance, care or transportation provided to me in the event of an emergency.

Photo Release: I hereby authorize Samaritans of Merrimack Valley & Family Services of the Merrimack Valley (FSMV) , and other authorized personnel, to use my likeness, and the likeness of my children (if applicable), in a photograph or video taken during the Walk for Hope on October 19, 2024.  Attribution of my, or my child(ren)’s, name and quoted statements may be included.  I understand that these images and attributions may be included in all of FSMV’s & Samaritans publications, including but not limited to outreach, marketing, fundraising, printed and digital publications including social media (Twitter, Facebook and YouTube).  I understand and agree that any photograph or image using my likeness will become property of FSMV and will not be returned.  I also acknowledge FSMV’s right to crop or treat any photographs and edit any quotes at its discretion and that the FSMV may choose not to use my photo and/or quote at this time, but may do so at its own discretion at a later date.

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