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, Columbus School, the City of Bridgeport,, 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.
PRINT OUT THIS APPLICATION AND MAIL WITH CHECK
CIRCLE ONE: 5K RUN FITNESS WALK KIDS RUN
LAST NAME:____________________________ FIRST NAME: ____________________________
SEX: ________ DATE OF BIRTH: _______________ AGE ON RACE DAY: _______
ADDRESS:___________________________________________________
CITY: _________________________________ STATE: ________ ZIP: _________
TELEPHONE: ___________________________
T SHIRT: S M L XL (First 100 Only)
SIGNATURE: ____________________________________________
(parent or guardian must sign if under 18)
Entry Fees: 5K Run: $18.00 Pre-Reg - $20 Race Day.
2 Mile Walk: $10.00
Kids Run: $5.00
Make check payable and mail with application to:
Columbus School
C/O Ron Rapice
50 Pearsall Way
Bridgeport, CT 06605