In consideration of my entry being accepted intending to be legally bound, I do hereby for myself , my heirs, executors, and administrators waive, release and forever discharge any and all rights for claims and damages, which may have and herein after accrue to me against the Valley YMCA, 5K Run, officer, members, games director and/or agents which may be sustained and suffered by me in connection with my association with or entry in this Valley YMCA 5K run.
PRINT OUT THIS APPLICATION AND MAIL WITH CHECK
CIRCLE EVENT: 5K 2 Mile Walk LAST NAME: __________________________________________ FIRST NAME: ______________________________ SEX: ____________ BIRTH DATE: _______________ AGE ON RACE DAY: _______________ ADDRESS:___________________________________________________ CITY: _________________________________ STATE: ________ ZIP: _________ TELEPHONE: ___________________________ EMAIL: ____________________________________ T SHIRT: S M L XL ON LINE PRINTABLE APPLICATION : www.hitekracing.com
SIGNATURE: ____________________________________________
(parent or guradian must sign if under 18)
ENTRY FEES: 5K: $15 Pre-Reg - $20 Race Day
2 Mile Walk: $10 Pre-Reg - $12 Race Day
MAKE CHECK PAYABLE AND MAIL TO:
VALLEY YMCA 12 State Street Ansonia, CT 06401