Greenway 5K Charity Run
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 Derby, Bernardo Council #1350 Knights of Clolumbus, 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.
PRINT OUT THIS APPLICATION AND MAIL WITH CHECK
LAST NAME:___________________________________________ FIRST NAME: ________________________
SEX: _________ BIRTH DATE: _______________ AGE ON RACE DAY: _______________
ADDRESS:_____________________________________________________________________
CITY: _________________________________ STATE: ________ ZIP: _____________
TELEPHONE: _________________________ EMAIL: ____________________________________________
T SHIRT: S M L XL XXL ON LINEPRINTABLE APPLICATION :
www.hitekracing.comPlease check applicable special categories:
**Children’s Events will be
registered Only on Race Day ($5.00 suggested donation)
ATHLETE SIGNATURE: ____________________________________________
(parent or guradian must sign if under 18)