Falmouth Road Race - Spaulding Race for Rehab

Join Spaulding’s Race for Rehab Team for the 2023 ASICS Falmouth Road Race, the summer’s premier running event, on Sunday, August 20th.

Applications are open!

2023 Falmouth Road Race Application

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Name*

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Address*

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Phone (Cell)*

Phone (Home)

Email*

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Gender*

Birthdate*

Employer*

Job Title*

My employer is a matching gift company*

Application Type*

I’m applying to run the Falmouth Road Race on August 20th and need an entry.

I already have a confirmed entry.

I have been a member of Spaulding's Race for Rehab Team in the past:*

If so, please specify the year(s):*

I am a Spaulding employee:*

If so, please list years employed by Spaulding and site:*

How did you hear about Spaulding's Race for Rehab Falmouth Road Race Team?*

If being referred by a staff member, alumni or former patient, please include his/her name.

Why do you want to run the Falmouth Road Race on behalf of Spaulding Rehabilitation?*

Describe your personal connection to Spaulding and/or rehab medicine. Please be specific in your response.

My fundraising goal is:*

$750

$1,000

$2,000

Other

My proposed fundraising strategy is:*

Emergency contact name:*

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Relation to emergency contact:*

Emergency contact phone number:*

Please review the following information carefully.

Spaulding’s Race for Rehab Team Terms and Conditions:

I, the “Participant,” wish to participate in the 2023 ASICS Falmouth Road Race, being held on August 20, 2023, as a member of Spaulding Rehabilitation’s Race for Rehab Team. I agree to raise and/or contribute a minimum of $750 to Spaulding and will be personally responsible for the difference if I fail to collect the required funds by August 21, 2023. To secure my spot on the 2023 Race for Rehab Team, I will set up my personal fundraising page at the direction of team management and will provide a valid credit card with an expiration date after August 21, 2023. Spaulding Rehabilitation reserves the right to charge my credit card to fulfill my commitment. I also understand that Spaulding has the authority to rescind my entrance to the 2023 ASICS Falmouth Road Race at the discretion of team management for misconduct and/or inadequate fundraising.

I understand that I may cancel my participation with Spaulding’s Race for Rehab Team prior to June 16, 2023, by contacting Reesa Morabito, Manager of Stewardship Events at rmorabito@partners.org or 617-952-6881. Funds raised will not be returned or refunded under any circumstance. I understand and agree that injury, illness, travel complications and force majeure prohibiting my participation in—or completion of—the 2023 ASICS Falmouth Road Race, does not exempt me from the fundraising requirement and I will be responsible for all fundraising commitments. Entries are non-transferrable and cannot be deferred to a future year under any circumstance.

In consideration of my accepting this entry, I hereby for myself, my heirs, executors, and administrators, waive and release all rights for claims and damages I may have against Spaulding, its employees, volunteers, officers, and sponsors for any and all injuries suffered or sustained by me in said event, in the training and planning sessions for said event, or from any of the preceding. I further attest and certify that I am physically fit—verified by a licensed medical doctor—and will sufficiently train for competition in the event. I also grant permission for use of my name, photograph or voice in broadcast, telecast, print or any other account of this event—indefinitely—and agree to waive any compensation for such use.

I declare that I have exercised my own judgment in signing this agreement and I further declare that the decision to sign this agreement was voluntary and not based on—or influenced by—any representative of Spaulding. I certify that I carry paid up health and accident insurance coverage that will be in effect through August 21, 2023. In the event of an illness, injury or medical emergency during the 2023 ASICS Falmouth Road Race—or in the training and planning sessions—I hereby authorize and give my consent to Spaulding to secure from any accredited hospital, clinic and/or physician any treatments deemed necessary for my immediate care. I agree that I will be fully responsible for payment of all medical services and treatments rendered to me including but not limited to medical transport, medication, treatment, and hospitalization. By signing below, you are agreeing to the Terms and Conditions set forth by Spaulding Rehabilitation as a member of the Race for Rehab Team. Additionally, you agree to all Terms and Conditions set forth by the race organizers to participate in 2023 ASICS Falmouth Road Race.

I agree with the above statement*

I agree

Electronic Signature*

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