Christmas Village

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 PAL, PAL Buccaneers Drum & Bugle Corps; HI-TEK Racing, LLC, Town of Trumbull, City of Bridgeport,  the police departments,  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. Applications for miniors, under the age of 18, will be accepted with a parent's signature.


LAST NAME:____________________________ FIRST NAME: ____________________________

SEX:	________ DATE OF BIRTH: _______________ AGE ON RACE DAY: _______


CITY: 	_________________________________ STATE: ________ ZIP: _________

TELEPHONE: ___________________________ EMAIL: _____________________________

T SHIRT: ADULT- S   M   L   XL    


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

Entry Fees:	$20.00 Pre-Reg -  $25 After and on race day.
                (70 & Over and 8 & Under Free!)
Make check payable and mail with application to:
C/O Pat Rouse - Christmas Village Run
68 Meadowside Road
Milford, CT 06460

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