Registration

Bears' Daniel Manning
2010 Chicago Funfest Benefit
Events for Adults, Kids & Families!

Benefiting the Danieal Manning Adopt.A.High School Initiative, whose mission is to offer academic & ACT/SAT assistance to under-priviliged students.

NFL players will autograph t-shirts. Pre-order your t-shirts and save over $$!

Registration

Please help us cover the expense of producing the event by making a donation below. All payments should be made by credit card or check made payable to: Danieal Manning Fund, and mailed to Flying Colors Sports, 8270 Miranda Pl, West Chester OH 45069.

An acceptance email will be sent within 24 hours, once your application has been approved. For questions, contact us at info@flyingcolorssports.com.

Primary Contact Name:
Email Address:
Confirm Email Address:
Address:
City:
State:
Zip:
Friday Funfest Tickets (# x $40.00=):
Name of AMAZING RACE Team Captain:
RACE Gold Level Pass (# x $100.00=):
RACE Silver Level Pass (# x $60.00=):
RACE Spectator Pass (# x $10.00=):
RACE Headstart Tokens (# x $10.00=):
Autograph Tshirts (# x $15.00=):
General Donation:
TOTAL PAYMENT:
PAYMENT METHOD (Visa, MC, Amex, Disc or Mailing Check):
Card Number:
Exp Date:
How did you hear about Event? (Website, Flyer, Email, School, Newspaper, TV, Radio, Friend, Other):
I have read, understood, and accept the Medical/Liability agreement at the bottom of page. My submission of this form shall act as my legal signature.
Comments:

The individual identified on this form understands that all participants are expected to abide by the activity rules. The director has the authority to require individuals to leave due to conduct and misappropriate behavior. As a result, no refund is required.

Further, I do release and hereby agree to hold blameless activity sponsor, and its employees and agents from any and every claim arising, or which may be asserted by me or by any member of my family by reason of participating in any activities associated with the activity. I also release the lessor of properties on which the activity is held.

Further, I do authorize the sponsor of this activity in the event I cannot be reached by phone, to give consent to a physician and/or hospital for emergency medical or surgical treatment. It is understood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment.

Further, I do certify that said individual is covered by adequate accident insurance. My consent and signature is given below. I have read and agree to the information given in this entire form.

Further, I do authorize the activity sponsor to use my photographs and video footage shot at the activity for media and promotional purposes.

For minors: I, the parent or legal guardian of the individual listed on this form, certify that he/she has my full approval to participate in this activity.