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“Hoops for Kait” Free Throw Fundraiser
Sunday, April 17, 2011
Registration 12:00PM
Event Starts at 1:00PM
Event Application – ALL Participants
MUST COMPLETE FORM
Last Name______________________
First Name______________________
Address____________________________________________________
City_______________________ State______ Zip______________
Phone___________________ Email____________________________
Age_____ Date of Birth (as of Dec. 31 2011)____________________________
Entrance Fee: ALL PROCEEDS DONATED TO THE KMA FOUNDATION
3rd – 5th Grades _________ (Pre Registration Fee – $10.00 Per Child / Day-of Fee – $15.00 Per Child)
6th – 8th Grades _________ (Pre Registration Fee – $10.00 Per Child / Day-of Fee – $15.00 Per Child)
High School to Adult ________ (Pre Registration Fee – $15.00 Per Adult / Day-of Fee – $20.00 Per Adult)
T-Shirt size: (circle one) Small – Medium – Large – X Large – XX Large
Please read carefully before signing: In consideration of the acceptance of my entry in the “Hoops for Kait”
Free Throw Fundraiser I, heirs, executors and administrators hereby discharge Cape May County, the Borough of
Wildwood Crest, The Kaitlin M. Anzelone Foundation, the Wildwood Crest Recreation Center and all the sponsors and
producers of this event, from all liabilities, actions, claims, demands, costs and expenses which I may now or in the
future have against them arising out of my participation in the above mentioned “Hoops for Kait” Free Throw
Fundraiser, including but not limited all injuries that may be suffered by me. I attest and verify that to the best of my
knowledge, my physical condition and fitness are adequate for me to safely compete in the event mentioned above
and that no physicians or other individual has advised me again competing in any part of the event.
I certify that I have read this document and attest to its contents.
Signature___________________________________date__________
(Signature of parent under 18)
Make Checks Payable To: The KMA Foundation
Mail To: 127 W. Newark Ave.
Wildwood Crest, NJ 08260
Do not mail in registrations after Monday – 04/11/11
There will be event registration starting at 12:00pm
For more information visit our website at www.kaitlinanzelonefoundation.org
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