CROP FOR A CAUSE AND STAMP OUT CANCER

Chickasha, May 1—Grady Memorial Hospital Relay for Life Team is hosting “Crop for a Cure
and Stamp Out Cancer”, a first-time scrapbooking/stamping/card making Relay fund-raising
event. The event will be held on Saturday, May 1, 2010 from 9:00am to 6:00pm at the Five Oaks
MedicalGroup at 2100 Iowa, Chickasha, Oklahoma. All proceeds will be donated to the
Team Grady Relay for Life Teams and the American Cancer Society.

A registration fee of $25 will get participants nine hours of scrapbooking, door prizes,
lunch and refreshments, and exhibitor booths. Registration will be held from 8:00am
until 9:00am the day of the event. There will be a $5 discount for registering prior
to the event. Space is available on a first come, first serve basis.

The Team Grady Team Captains are excited about raising money, but also believe it will
be a great time of fellowship and remembering those affected by cancer. “I have been
scrapbooking for about a year but have not had the honor of spending the day at
an event that has so much importance,” said a Team Captain, Michelle McDaniel.
“Cancer has touched my life in so many ways and Relay for Life is our hope for the cure.”

From beginner to the experienced, everyone (over the age of 12) is welcome! Various
vendors from many home based and local businesses will be set up for participants to visit.
Many of the exhibitors will have cash and carry items and be donating door prizes.
Participants are encouraged to bring unneeded supplies for the Bargain Area. Plan to bring
extra money for cool stuff available at the vendor booths, Bargain Area, bake sale,
and Cricut Corner (furnish your own cutting mat).

For more information or to register, please contact Michelle McDaniel at 405-779-2287 or
405-609-4569. You can also download the registration form at www.gradymem.org.

“CROP FOR A CURE TO STAMP-OUT CANCER” EVENT
(SPONSORED BY TEAM GRADY – RELAY FOR LIFE)

PARTICIPANT INFORMATION AND REGISTRATION
REGISTRATION FEE: $25.00 ($5 Discount when you Pre-Register)
NAME

ADDRESS/CITY/STATE/ZIP CODE

CONTACT NUMBER (HOME/WORK/CELL)

EMAIL

CROPPING IN MEMORY OF

CROPPING IN HONOR OF

Special Note:

• All attendees understand that as an event participant, their photo may be taken
at any time during the event and that such photos may be used in future publicity endeavors.
By registering for this Team Grady Relay for Life event, you indicate that you have reviewed
this and other event policies and that you give your consent for use of these photos in
any future Team Grady Relay for Life promotional material and/or publicity campaigns.
• No refunds will be given. However, your registration fee is transferable
for this event only.
• Team Grady Relay for Life reserves the right to cancel this event.
In the event of any such cancellation, registrants will be notified and all paid
fees will be refunded.
• No one under the age of 12 may attend. Anyone under the age of 18 who
registers must be accompanied by a registered adult at the time of entry.
Please use your best judgment when deciding to register your child. They are more
than welcome but keep in mind that most of the participants are adults.
• No alcohol or smoking allowed on the premises.

SIGNATURE:
I have read and signed the Assumption of Risk and Release Waiver

ASSUMPTION OF RISK AND RELEASE WAIVER
By signing the Assumption of Risk and Release Waiver, the individual named below
wishes to participate in the “Event/Activity” described below and recognizes that
risks of damage or injury arising from this event or from other activities
(including travel) may be associated with participation in the Event/Activity.

EVENT/ACTIVITY: “Crop for a Cure to Stamp-Out Cancer”
SPONSORED BY: Team Grady – Relay for Life
START DATE: May 01, 2010
END DATE: May 01, 2010

By his or her signature below, the participating individual voluntarily agrees to assume
and/or incur all risks of loss, impairment, damage or injury of whatever kind, that may
be sustained or suffered by participation in this Event/Activity whether or not the result in
whole or in part by acts of omission, negligence, or other unintentional fault of the
Event/Activity or Grady Memorial Hospital /Five Oaks Medical Group. In addition, the
participant, including his/her heirs, assignees, and personal representatives, hold harmless
and indemnify Grady Memorial Hospital / Five Oaks Medical Group from and against
any claims, demands, actions, causes of action, account of property damage or personal
injury arising out of or attributable to the individual’s travel to or participating in the
Event/Activity.

This Assumption of Risk and Release Waiver applies to Grady Memorial Hospital / Five
Oaks Medical Group and all of its trustees, officers, directors, managers, servants, agents,
staff members, students, volunteers, employees, advisors, and/or representatives.

The undersigned acknowledges that he/she has read and understands this document.
Executed as of this ___________________ day of _______________________ 2010.
(date) (month)

______________________________________________________________________
Participant’s Name (please print)

______________________________________________________________________
Address, City, State, and Zip Code

______________________________________________________________________
Participant’s Signature

______________________________________________________________________
Signature of parent or guardian (if participant is under 18 years of age):





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