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 for claims for damage I may have against RC Bigelow, Inc. or any and all race sponsors, or the cities and towns in which this race is contested, their representatives, successor or assign for any and all injuries suffered by me in said event. I attest and verify that I am physically fit and sufficiently trained for the completion of this event and my physical condition has been verified by a Licensed Medical Doctor within the last six months. Further, I hereby grant full permission to any and all of the foregoing to use my photographs, videotapes, motion pictures, recordings or any other record of this event for any purpose whatever, without compensation or remuneration.
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EVENT CIRCLE ONE: 5K ROAD RACE 2 MILE FITNESS WALK KIDS FUN RUNS
NAME: ______________________________________________________ SEX: ____________ DOB: ____________ AGE ON RACE DAY: __________ ADDRESS:___________________________________________________ CITY: _________________________________ STATE: ________ ZIP: _________ TELEPHONE: ___________________________ EMAIL: _____________________________ T SHIRT: ADULT: S M L XL YOUTH: S M L SIGNATURE: ____________________________________________ (parent or guardian must sign if under 18) Entry Fees: 5K RUN: $20.00 By SEP 18th - $25 After and on race day 2 MILE WALK: $15 By SEP 18th - $20 After and on race day KIDS FUN RUNS: $10 Make check payable and mail with application to: Bigelow Tea Community Challenge C/O HI-TEK Racing 7365 Main Street, #183 Stratford, CT 06614
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