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Webster County Community Hospital

Community Health Challenge

Competition begins Monday, January 13, 2014
Ends Friday, April 11th, 2014

Cash prizes for top 3 teams

Registration Fee: $15

Please bring your registration fee to the clinic at your first weigh in the week of January 6-10, 2014 between 8am-5pm.

Registration Deadline is Friday, January 10th
* Name
* Address
  Phone #
  Team Name
* E-mail
  Signature Authorization
I hereby waive & release all rights & claims for damages I have against the organizers & sponsors of the WCCH Community Health Challenge to be held January 13,2014 through Friday, April 11, 2014 and for any and all injuries suffered by me in this event. I hereby authorize the organizers and support personnel to provide any appropriate medical aid I may require during this event. I agree to the use of my name/picture in publicity and media coverage of this event.