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Craig A Petrella Memorial 5k Pump & Run
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1.
First Name
(Required.)
2.
Last Name
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3.
Event Category
(Required.)
5k Pump and Run (must be last 18 years old to participate)
5K Run Only
5K Walk Only
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4.
Age
(Required.)
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5.
Gender
(Required.)
Female
Male
6.
Phone Number
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7.
Email
(Required.)
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8.
Zip Code
(Required.)
9.
Shirt Size (Must Register by July 1)
Small
Medium
Large
XL
2XL
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10.
Payment Option - $30 per participant
(Required.)
Cash
Check (payable to the Jefferson County General Health District)
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11.
WAIVER - In consideration of the privilege to participate in the event known as the Craig A Petrella Memorial 5K Pump & Run, I do hereby covenant and agree with the City of Steubenville that I will hold and save harmless and do by these covenants agree to forego any claim or suit against the City of Steubenville, SYNA, and the Jefferson County General Health District as a result of any injuries which may occur to me as a result of my participation in the above-referenced activity. I understand that the activity in which I am going to participate may or could result in bodily injury, damage to my person and/or death. On behalf of myself, my heirs, assigns and next of kin, I waive all claims for damages, injuries and death sustained to me that I may have against the City of Steubenville as it relates to my participation in the above-referenced activity.
I further agree that this release and covenant is binding upon me and shall extend to my heirs, executors, administrators, successors, and assigns and that no action or claim shall be filed by any of them for their own behalf or on behalf of my estate as a result of my participation in the above referenced program.
I have read, understand and fully agree to the terms of this WAIVER AND RELEASE. I understand and confirm that by signing this WAIVER AND RELEASE I have given up considerable future legal rights. I have signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law. I am 18 year of age or older and mentally competent to enter into this waiver.
(Required.)
Yes
No
