7.ª edición anual Registro anual de la caminata/carrera/roll 5k virtual de QLife
Es usted:
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Empleado
Esposo(a) de un empleado
Familia/amigo(a) de un empleado
Nombre
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Nombre
Apellido
Fecha de nacimiento:
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-
Month
-
Day
Year
Fecha
ID de empleado
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Si conoce el ID de empleado(a) de su esposo(a), colóquelo aquí para créditos hacia el incentivo monetario de $250 de QLife:
¿En qué Estado vive?
Alabama
Alaska
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Virginia
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Método de contacto preferido:
Correo electrónico
Teléfono
Yo hago donaciones al Grupo de Trabajo contra el Hambre (Hunger Task Force)
Si
No
Prefiero no contestar
Yo hago donaciones a Alimentando América (Feeding America)
Si
No
Prefiero no contestar
Porfavor anote la cantidad monetaria que donó al Grupo de Trabajo contra el Hambre (Hunger Task Force)
Por favor anote la cantidad monetaria que donó a Alimentando América (Feeding America)
Correo Electrónico
*
example@example.com
Número de Teléfono
-
Código de área
Número de teléfono
QLife Virtual 5K Release
By signing below, I agree to all terms and conditions o fthis QLife Virtual 5K Release (the “Release”): I agree that I am voluntarily and freely participating in the QLife Virtual 5K (the “Activity”) which will occur at a location of my choosing. I understand that the Activity is a sporting event that involves walking, running, other ordinary activities involved in walking and running, and waiting for or spectating all of these activities. I understand that the Activity may be physically demanding and potentially dangerous. I understand that my participation in the Activity may involve risks, dangers, and hazards that may cause serious personal injury, disability and/or death and that injuries are a common and ordinary occurrence. Injuries include, but not limited to, muscle or tendon soreness or injuries, ligament or skeletal injuries, bruising or cuts, fractured or broken bones, difficult breathing or worsening of asthma or other respiratory disorder, head injuries, heart attack, and/or death. I have determined that I am physically fit and am able to participate in the Activity. I acknowledge Quad/Graphics, Inc., its subsidiaries and affiliates (collectively, “Quad”) will not make any determination regarding my ability or fitness to participate in the Activity. I have consulted with a physician, if I determined that it was necessary, to ensure that I am able to participate in the Activity. I acknowledge that Quad has not made any representation about the safety of the Activity. I understand that I may choose not to participate in the Activity or any specific aspect of the Activity. If I am experiencing a medical emergency, I will call 911.I expressly, willingly, and voluntarily accept and assume full and sole responsibility for the risks involved with my participation in the Activity, including the risk of injury, harm, or death, whether caused by my own or any other person or entity’s actions, negligence, or intentional conduct. I expressly, willingly, and voluntarily release Quad and its employees, shareholders, directors, trustees, managers, officers, administrators, partners, agents, representatives, contractors, subcontractors, successors, heirs, assigns, affiliates, and representatives from, and hold them harmless for, any and all liability, claims, rights, demands, or causes of action, known or unknown, based on my participation in the Activity. I understand that signing this Release, or a release in a form I propose that is acceptable to both Quad and myself, is a requirement to participate in the Activity. This Release shall remain in force and effect unless and until I provide written revocation to Quad at the address above. If I revoke this Release, I understand that I must immediately stop any further participation in the Activity. Electronic Signature I agree and acknowledge that I am asked to sign this Release with an electronic signature. I have read the following carefully regarding the electronic signature process. To sign this Release electronically, I have been required to: Access JotForm and the specific registration form for the Virtual 5K; Enter my first and last name; Enter my Employee ID or the Employee ID of the employee to whom I am related; Review this Release; and Click the box at the bottom of this document where it states “Submit”. I understand that my electronic signature will not be applied to this Release until I correctly complete all of these steps. I understand that I will have access to this Release to download or print. Once the signature process is completed, my electronic signature will be binding as if I had physically signed the document by hand.BY SIGNING BELOW, I AGREE THAT I HAVE READ THIS RELEASE, FULLYUNDERSTAND ALL OF ITS TERMS, AND AGREE TO THE RELEASE OF MY OWN FREE WILLINTENDING TO BE LEGALLY BOUND BY ITS TERMS AND CONDITIONS. IF I AM UNDER18 YEARS OF AGE, MY PARENT OR GUARDIAN IS CONSENTING AND GIVING PERMISSION FORMY PARTICIPATION IN THE ACTIVITY BY SIGNING THIS RELEASE ON MY BEHALF.
Firma
Someter
Should be Empty: