Agreement and Release/Waiver:
1. Register by filling up this form completely. Please send all
completed Registration forms to: Please carefully review the following before completing
In consideration of being permitted to participate in the
Victor Z. Manlapaz MILLION HECTARE WALK (the “Event”), I hereby
Project Officer, Environment declare, agree and confirm as follows:
Coca-Cola Foundation Philippines, Inc.
1890 Paz Guazon Ave. 1. That I am physically fit to participate in the Event
Paco, Manila and that i have no medical condition/reason that
Tel. (02) 866-2582 would restrict my ability to participate in the Event
Fax (02) 866-2398 or would cause or aggravate any medical
Mobile (0917) 886-6054 condition.
2. I agree to the use of my picture, name and/or city/
Forms must be received by the Coca-Cola Foundation no later town of residence, without compensation, for
than October 24, 2008 Friday publicity reasons.
By participating in the Event, I on behalf of myself and those
2. Registration Fee of P300 per volunteer shall be shouldered by minors (if any) listed below and for whom I am parent and/or legal
the Coca-Cola Foundation. * Not inclusive of P8 entrance fee to guardian, hereby release, waive and forever discharge all
Ninoy Aquino Parks and Wildlife Center sponsors, officials, organizers and all other associations involved
in the Event, together with each of their respective employees,
agents, directors, officers, members and officials(collectively
referred to as the “Releasees”), of and from any and all
proceedings, claims, demands, damages, costs, expenses,
actions and causes of action (whether known or unknown)
whatsoever, both in law and equity, which I now have or may
hereafter have for or by reason of or in respect of my participation
in the Event, whether as a spectator, participant or otherwise, and
notwithstanding that same may have been contributed to, or
occasioned by, the negligence of any of the Releasees.
Walker Information: I further hereby undertake or hold and save harmless all of the
Releasees from and against any and all liability incurred by any or
___ Haribon Member ____ Non-Member all of them as a result of, or in anyway connected with, my
___ Current ____ Would you like to participation and/or the participation of any of the minors listed
___ For Renewal become a member/donor? below in the Event.
___ Mr ___ Mrs ___ Ms By submitting this entry, I acknowledge having read, understood
and agreed to the above waiver/release.
First Name: _______________________________ The provisions of this agreement, waiver/release shall enure to
the respective heirs, executors, administrators, personal
Last Name: _______________________________ representatives, successors and assigns of each of the
Age: _________ Releasees and shall be binding upon my heirs executors,
administrators and personal representatives.
The provisions of this waiver/release shall be governed by the
_________________________________________ laws of the Republic of the Philippines.
Cellphone: (__ __ __ __) __ __ __ - __ __ __ __ I am signing this waiver/release on behalf of myself and the
following minors (if any) for whom I am a parent and/or legal
Email: ____________________________________ guardian.
Day-time contact number: __ __ __ - __ __ __ __ (If under 18 years of age, Parent/Guardian must sign)
Company : Coca-Cola Philippines Date: ___________________________________________
Estimated t-shirt size: S M L XL Other: ________
Which route? _____ Short: 360 meters Printed name over Signature
_____ Long: 1.5km