BEARDSLEY BEAST 5K

In consideration of acceptance of this entry, I the undersigned intending to be legally bound, do hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against,  the race director and officials, the City of Bridgeport,  Bridgeport Field of Dreams Foundation, Esiason Foundation for Cystic Fibrosis, HI-TEK Racing, their representatives, any and all race sponsors and supporters, volunteers, their agents, successors and assigns, for any and all injuries suffered by me in said event. I assume all risks with entering this event, including but not limited to falls, contact with other participants, effects of weather, including high heat and humidity, extreme cold or wind, traffic and the condition of the road. All such risks being known and appreciated by me. I attest and verify that I am physically fit and sufficiently trained for the completion of this event. Further, I hereby grant full permission to any and all the foregoing to use my photographs, videotapes, motion pictures, recordings, or any other record of this event for any legitimate purposes without compensation or remuneration. I know that bicycles, in-line skates and skateboards are not allowed on the course.


PRINT OUT THIS APPLICATION AND MAIL WITH CHECK



LAST NAME: _______________________________ FIRST NAME ____________________

ADDRESS:___________________________________________________

CITY: 	_________________________________ STATE: ________ ZIP: _________

SEX:	______ 	DOB ____________ AGE ON RACE DAY: _______________ 
TELEPHONE: ___________________________ EMAIL: ________________________________________

T SHIRT:    S    M     L     XL 

SIGNATURE: ____________________________________________
                        (parent or guradian must sign if under 18)


Entry Fees: $20.00 By Apr 30, 2015 -  $25 After and on Race Day
                   Kids 16 & Under $10.00
                   

Make check payable and mail with application to:
Field of Dreams Foundation/BPEF
C/O Chris Kinsley
278 Fairview Avenue
Fairfield, CT 06824

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