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, Bridgeport Hospital, The Bridgeport Bluefish, Aquarian, The Bridgeport POlice Department, the City of Bridgeport, MS Running Productions, 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
CIRCLE ONE EVENT: 5K RUN/WALK 5K WHEELCHAIR RACE 1 MILE WALK CHILDRENS FUN RUN
LAST NAME: ________________________________________ FIRST NAME: ___________________________ ADDRESS:___________________________________________________ CITY: _________________________________ STATE: ________ ZIP: _________ SEX: ______ DOB ____________ AGE ON RACE DAY: _______________
TELEPHONE: ___________________________ EMAIL: _________________________________________
BRIDGEPORT HOSPITAL EMPLOYEE: YES NO IF ON TEAM LIST TEAM NAME (BPT HOSP EMPLOYEES ONLY): ____________________________________
T SHIRT: ADULT: S M L XL or CHILD: S M L
SIGNATURE: ____________________________________________
(parent or guardian must sign if under 18)
Entry Fees: 5K: $17.00 By May 20, 2008 - $20 Race Day
1 Mile Walk: $17
Children's Fun Run: $5.00
Make check payable to: Bridgeport Hospital Foundation
Mail to: Bridgeport Hospital Home Run Bridgeport Hospital Foundation 267 Grant Street Bridgeport, CT 06610