Ultimate Hike – Shenandoah Recommitment 2025 "*" indicates required fields Step 1 of 4 25% Welcome to recommitment! Please make sure you complete the form and return all materials in time to arrive at CureSearch as soon as possible, but no later than Wednesday, April 2, 2025, to ensure we have time to make arrangements for you. If you have any questions, please email us at chase.carter@curesearch.org as soon as possible.Please read the Participant Release & Consent Form.* I acknowledge that I have read, understand and agree to participant release and consent I, (the “Participant”) intending to be legally bound, understand and agree that I am voluntarily participating in CureSearch’s Ultimate Hike program (the “Program”) and all of its activities including, but not limited to training for and participating in the Program at my own request and at my own risk. I acknowledge that I am aware of the risks inherent in training for and participating in the Program and certify that I am physically fit, have not been otherwise informed by any physician and know of no restrictions imposed on me by a physician that would in any way prevent me from actively participating in the Program. I acknowledge the CureSearch for Children’s Cancer recommends that all Ultimate Hikers consult a physician before participating in the Program. I further state that I will actively train for the program and generally follow the suggested training regimen from CureSearch. If at any time during my participation in the Program, I am told that my continued partition is not medically advisable by either a physician or Ultimate Hike Staff, I will discontinue participation. In consideration of CureSearch’s sponsorship of this Program, and my being permitted to participate in the Program, I, on behalf of myself, my successors in interest, heirs, assigns and representatives, hereby fully release and hold harmless CureSearch and its chapters, their Officers, Trustees, agents, employees, volunteers and any medical providers working for or on behalf of the Program and representatives, successors and assigns (be they individuals or organizations), together with their insurers and sponsors, of and from any and all liability, claims, damages, actions and causes of action whatsoever on account of any and all loss, known or unknown, damage or injury to person (including death) or any other loss to person or property or inconvenience whatsoever, suffered by me at any time hereafter arising from my voluntary participation in this Program, whether resulting from CureSearch’s negligence or otherwise (collectively, “Liabilities”). I also understand that hikers will be required to maintain a minimum pace while on the course, and I will be moved ahead if I cannot maintain the minimum pace required. I also hereby give permission to CureSearch touse without charge my name, picture and voice in any broadcast, telecast, print account or any medium of this Program (the “Personal Release”). I understand that this Personal Release is perpetual in time and that it encompasses, without limitation, any copyright or right of publicity or privacy that I have in my name, picture and voice. I represent and warrant that I am legally able to provide permission with respect to any minors or other third parties for which this policy may be applicable. I also hereby grant permission to CureSearch in connection with the Program (I)to render preventative or first-aid assistance or seek treatment or medical care that it seems reasonably necessary, including hospitalization, for my health and well being; (II)to use and disclose my personal health information (“PHI”) in min connection with the foregoing; and (iii) to use my PHI as necessary for other purposes related to my care and treatment. I also hereby grant my consent to CureSearch to give out my PHI to doctors, hospitals, ambulance companies, coaches, family members and others involved in such care and treatment. My PHI may also be used as necessary for the proper management and administration of CureSearch. I acknowledge that the nature of endurance events is unpredictable, and that extreme weather, fire, flood, mudslides, government shutdowns, low participation, widespread illness, and other factors may require CureSearch to alter, cancel, suspend, or otherwise change an event. If this happens, CureSearch staff will work diligently to find an acceptable solution. Event fees and funds raised are not refundable in these instances. This Release and Consent will be governed by and subject to laws (except the choice of law principles) and exclusive jurisdiction of the courts of the State of Maryland. Are you a Hiker or Volunteer/Coach?* Hiker Volunteer/Coach Your Name* First Last Your Email* Your Cell Phone Number*Emergency ContactsPlease help us keep you safe hike weekend. Each participant is asked to provide contact info for two non-hiking emergency contacts. Please share their info here:Emergency Contact #1Name* First Last Relationship To You*Cell Phone Number*Email* Emergency Contact #2Name* First Last Relationship To You*Cell Phone Number*Email* Your fundraising minimum is $2,500 as an individual, minus any fundraising credits you have earned. For purposes of recommitment, please use the amount of money you have raised on your fundraising website – we cannot count funds that have not been turned in or matching gifts that have not yet been received towards recommitment. If you are on a team and have not reached your goal, but the total dollar amount raised by your team (according to the website) equals more than $2,500 times the number of team members, then you have met your minimum.Based on the information above, have you completed your goal based on either individual or team funds?* Yes No – You will receive an email from Docusign on behalf of CureSesarch Ultimate Hike to securely submit your credit card information to guarantee your place as a participant in the Shenandoah Valley Ultimate Hike, May 17, 2025. When registering for the Ultimate Hike, all hikers commit to raise a minimum of $2,500 for CureSearch for Children’s Cancer. These minimums are set to ensure that CureSearch keeps our program costs low, maintains our credibility to you and our donors and, most importantly, maximizes the funds we invest in vital pediatric cancer research. Next, please tell us about your pace and your goals for hike day. Please select which describes you best:* I am a very fast hiker and want to finish as quickly as I can. I hike faster than most but am not in a hurry. My pace is average. I like to take my time and enjoy the scenery. What is your average pace per mile? This information helps us know when to have you start on hike day.There are two hike distances for hike weekend. Please select the distance you will be participating in on hike day: 21 miles 14.3 miles Is your goal to complete the entire distance you have selected?* Yes, absolutely Yes, but I will consider skipping sections depending on how I am feeling on the big day. No, I would like you to contact me about additional shorter options. Are there friends from your team or from training who you hope to hike with on the big day? If so, please list here: Are you participating in memory of someone who had childhood cancer? If so, what is the child’s name?*Please send a photo of the child you are hiking in memory of to chase.carter@curesearch.org by Friday, May 2, 2025.Are you participating in honor of someone who has or had childhood cancer? If so, what is the child’s name?*Please send a photo of the child you are hiking in memory of to chase.carter@curesearch.org by Friday, May 2, 2025.What size T-shirt would you like?*For Hiker AND Coaches/Volunteers XS Unisex Small Unisex Medium Unisex Large Unisex XL Unisex 2XL Unisex XS Ladies’ Cut Small Ladies’ Cut Medium Ladies’ Cut Large Ladies’ Cut XL Ladies’ Cut 2XL Ladies’ Cut Ultimate hike provides free rooms to participants based on double occupancy (two participants per room). If you would like your own room, or if you would like to share your room with non-hiking loved ones, you have the option to buy out your room and not share with another participant. You also have the option to arrive early or stay late. Let’s start with your room. Do you want to pay for your own room for $135 total?* Yes – you will receive a link to Classy to pay for your weekend additions. No – please pair me with another participant at no cost. Would you like to request a specific roommate? Yes No, please assign me a roommate. Roommate nameDo you wish to arrive early and spend the night on Thursday, May 15, 2025 for an extra $135* Yes, you will receive a link to Classy to pay for your weekend additions. No, I will not arrive a night early. Do you wish to stay late and spend the night on Sunday, May 18, 2025 for an extra $135?* Yes, you will receive a link to Classy to pay for your weekend additions. No, I will be leaving by checkout time on Sunday. How many beds do you prefer for your room?* No preference Two beds One bed Do you have any special requests for your room? We cannot guarantee special requests, but we will try our best. Do you have any dietary needs or food allergies? Please describe.We will provide turkey or peanut butter and jelly sandwiches on the trail on hike day. Please check everything that you would like on your sandwich:* Turkey American Cheese Mayo Mustard I prefer a Peanut Butter and Jelly Sandwich I need gluten free bread for my sandwich I will not need a sandwich Ultimate Hike provides each participant with a Friday night pasta party, Saturday night victory reception, and Sunday morning awards breakfast. If space allows, your guests are welcome to join us for all meals, but meals must be purchased in advance. If you are not planning to bring guests to meals, please skip this section.Friday night pasta partyHow many guests will you bring to the Friday night pasta party ($28 per guest)?Please enter a number greater than or equal to 0.Sunday awards breakfastHow many guests will you bring to the Sunday awards breakfast ($20 per guest)?Please enter a number greater than or equal to 0.*If your guests have any special dietary needs, please contact chase.carter@curesearch.org once you’ve completed this form. Total Amount Due Before submitting this form, please note that if you have funds due in the field above, you will receive an email with the total amount due, and a link to the payment form to pay for extras listed above (your own room, extra guest meals, etc). Please remember to submit this form in addition to your payment form!NameThis field is for validation purposes and should be left unchanged. Δ