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Participant's Contact Information


Parents' Information


Torch Run Waiver


Torch Run Waiver: I give permission for my child/children (listed below) to participate in the TORCH RUN - Champions Run for Life to be held Saturday, August 26, 2023 at the Shoreline Aquatic Park in Long Beach, California. I, for myself and my child/children, waive any and all claims for damages I or my child/children may have against MemorialCare, MemorialCare Long Beach Medical Center, MemorialCare Miller Children's & Women’s Hospital Long Beach, MemorialCare Medical Center Foundation, the Jonathan Jaques Children's Cancer Institute, the City of Long Beach, and any individual associated with the above for any and all injuries that I or my child/children might sustain in this event. I accept full responsibility for my child/children, and attest that my child/children, although he or she may be known to be under a physician's care, is physically fit to participate. My designate or I will be present with my child/children at the event. I will additionally permit the free use of my child/children's names and our pictures in broadcasts, telecasts, print, and in all Champions Run for Life Torch Run marketing and promotional campaigns.

Additional T-Shirts


CHILDREN'S T-SHIRTS:
Please choose the quantity of CHILDREN'S size shirts desired next to the size below. Each shirt is $10. This is in ADDITION to the T-shirt for the patient.

Additional Children's X-Small
$10
Additional Children's Small
$10
Additional Children's Medium
$10
Additional Children's Large
$10

ADULT T-SHIRTS:
Please choose the number of ADULT size shirts desired next to the size below. T-Shirts are $12 each.

Additional Adult Small
$12
Additional Adult Medium
$12
Additional Adult Large
$12
Additional Adult X-Large
$12
Additional Adult XX-Large
$12
Additional Adult XXX-Large
$12

Option #1: Day of Torch Run
Shoreline Aquatic Park
Saturday, August 26, 2023

Option #2: Jonathan Jaques Children's Cancer Institute Office
2653 Elm Avenue, Suite 200
Long Beach, CA 90806
Monday—Friday, 9am—5pm

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