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* 1. Name

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* 2. Gender

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* 3. Address

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* 4. City

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* 5. State

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* 6. Zip Code

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* 7. Home Phone

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* 8. Cell Phone

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* 9. Age on Race Day

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* 10. Birthdate

Date

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* 11. Emergency Contact

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* 12. Contact Phone

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* 13. Event: Check one

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* 14. T-Shirt Size: Check one

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* 15. Entry fee (Check one): Fee includes t-shirt, snacks, and complimentary water.

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* 16. Categories

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* 17. NOTE: Only Runners will be awarded prizes in this competition.
Awards:
1st Place runners (each category) will be awarded trophies
2nd Place runners (each category) will be awarded plaques
3rd Place runners (each category) will receive medallions
Medals will also be awarded to top finishers in youth categories,
Ages: 10-12; 13-15, 16-19
All participants under the age of 18 must be accompanied by a parent.

Release and Waiver (Please Read and Sign):
I know that running/walking is a potentially hazardous activity. I should not enter and run/walk unless I am medically able and properly trained. I know that, although police protection might be provided, there could be traffic on the course route; therefore, I assume the risk of running/walking in traffic. I also assume any other risks associated with running/walking this event including, but not limited to, falls, contact with other participants, and the effects of weather and conditions of the road. I understand I am solely responsible for my own safety while traveling to and from or participating in this event. Knowing these facts and in consideration of your acceptance of my entry, I hereby for myself, my heirs, executors, administrators, or anyone else who might sue on my behalf covenant not to sue, and waive, release, and discharge the sponsors or contributors of this event,any race officials, volunteers, the city and police agencies, their representatives successors or assignees from any claims of every kind or nature whatsoever, foreseen and unforeseen, known and unknown. The undersigned further grants full permission to use any photographs, videotapes, motion pictures, recordings, or another record of the event for any purpose. Minors will be accepted with  parent's signature.

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* 18. Signature

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* 19. Date

Date

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