Lifelinx/Catapult To Recovery

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 Town of Guilford, Lifelinx, the race committee, 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. A parent or guardian must sign for all minors.


PRINT OUT THIS APPLICATION AND MAIL WITH CHECK


OFFICIAL ENTRY FORM
EVENT: (CIRCLE ONE)    5K Run/Walk                 Kids Run            BBQ Only     BBQ ONLY NO SHIRT

LAST NAME:	__________________________________________ FIRST NAME: _____________________

GENDER:	____________ 	BIRTH DATE: _______________ AGE ON RACE DAY: _______________

ADDRESS:___________________________________________________

CITY: 	_________________________________ STATE: ________ ZIP: _________

TELEPHONE: ___________________________  School: ______________________________________

T SHIRT:  S   M   L   XL                  ON LINE PRINTABLE APPLICATION : www.hitekracing.com
SIGNATURE: ____________________________________________
           (parent or guardian must sign if under 18)

ENTRY FEES: Pre-Reg: 5K -  $18  Kids Race - $10
                            Race Day:  5K:  $20 - Kids Race - $15
                            BBQ Only $10 - $15 with Shirt
MAKE CHECK PAYABLE AND MAIL TO:

LIFELINX CORP

2785 BOSTON POST RD

GUILFORD, CT  06437

203-483-0399

LIFELINX@SBCGLOBAL.NET

 


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