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 Bridgeport Police Department, the City of Bridgeport, MS Running Productions, Black Rock Community Council, 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
LAST NAME: ________________________________________ FIRST NAME: ___________________________ EMAIL: ______________________________________________________________________ Please print email so that we can contact you with updates emergencies or cancellations. ADDRESS:___________________________________________________ CITY: _________________________________ STATE: ________ ZIP: _________ SEX: ______ DOB ____________ AGE ON RACE DAY: _______________
TELEPHONE: ___________________________ EMAIL: _________________________________________
T SHIRT: ADULT: XS S M L XL
SIGNATURE: ____________________________________________
(parent or guardian must sign if under 18)
Entry Fees: $28.00 Pre -Registration 19 - 69 $30 Late Reg & Race Day
$16.00 Youth 18 & Under - $20 Late & Race Day
$20 70+
Make check payable to: Black Rock Community Council
Mail to: MSRP 245 Laurel Street Stratford, CT 06615