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Autism Walk - Registration Form
Burkhart Walk for Autism
Sunday, April 23, 2023
2:00-4:00 p.m.
John Walker Soccer Complex
3901 10
th
Street
Lubbock, TX
*
I am joining as:
Please select
Team Captain/New Team
Team Member
Individual Walker
*
First Name:
*
Last Name:
*
Email:
*
Phone:
*
Street:
*
City:
*
State:
*
Zip:
Waiver: I, the undersigned, agree to indemnify and hold harmless Texas Tech University and the Burkhart Center from all cost, expense and liability arising out of my or my child's participation in this event to benefit the Burkhart Center. I do hereby waive all claims for damage or loss to me or my child's person or property which may be caused by an act, or a failure to act, by Texas Tech University and/or Burkhart Center, the University’s Regents officers, agents or employees arising directly or indirectly form my or my child's participation in this event; and I hereby assume liability for any loss, damage or other liability form such event. I grant full permission for organizers to use photos, videos, film or any record of this event in which I may appear for any legitimate purpose. Participants under 18 or incapacitated must have this form signed by a parent or guardian.
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