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 or Town of competition, 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 minors under 18 will be accepted only with a parent's signature.
PRINT OUT THIS APPLICATION AND MAIL WITH CHECK
OFFICIAL ENTRY FORM CIRCLE EVENT: 5 MILE RUN 2 MILE WALK KIDS RUN NAME: ______________________________________________________ SEX: ____________ BIRTH DATE: _______________ AGE ON RACE DAY: _______________ ADDRESS:___________________________________________________ CITY: _________________________________ STATE: ________ ZIP: _________ TELEPHONE: ___________________________ EMAIL: _________________________________________________________ T SHIRT: Y S M L XL ON LINE PRINTABLE APPLICATION : www.hitekracing.com
SIGNATURE: ____________________________________________
(parent or guardian must sign if under 18)
ENTRY FEE: $25 - $50 MAX PER FAMILY Please accept my additional donation of $ ____ to benefit the Madison Exchange Club
MAKE CHECK PAYABLE AND MAIL TO:
Madison Exchange Club C/O Frank Guarascio 121 Hammonassett Meadows Rd Madison, CT 06443