Spirit Run & Walk -
September 26, 2004
Web Entry Form
Check event:
r5K Run
r5K
Family Walk
First name_______________________ Last
name_____________________________________
Address______________________________________________________________________________________
City___________________________________ State________
ZIP_____________
Phone - day _________________________ Phone - evening
__________________________
E-Mail
_____________________________________________________________________
Spirit Entry Name in honor of someone who has
touched my life _________________________
Spirit Contribution in honor of someone who as touched my life $_____
Sex: r Male r
Female Age:_____________
T-Shirt size q M q L q XL
q XXL
q $20.00
5K run or walk
(entered by Sept. 17)
q $25.00
After 9/17
WAIVER (Must be signed)
I know that running and walking a road race is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I agree to abideby any decision of a race official relative to my ability to safely complete the run or walk. I also know that while police protection will be provided, there may betraffic n the course. I assume all risks associated with my voluntary participation in this event, including, All but not limited to, falls, contact with other participants,the effects of the weather, including extreme cold, snow, and ice, traffic, and the conditions on the road, al such risks being known and appreciated by me.Knowing these facts, and in consideration of you accepting my entry, I for myself, my heirs, executors, administrators, or anyone else who might claim on mybehalf, covenant not to sue and WAIVE, RELEASE and DISCHARGE: University High School, TrueNorth and Associates, Rock Solid Results, and Tuxedo Brothers,volunteers. Village of West Clay their representatives, successors or assigns from ANY AND ALL claims or liability, whether foreseen or unforeseen, for death,personal injury or property damage arising out of, or in the course of my participation in this event.I further grant full permission to The event coordinators and volunteers and/or agents authorized by then, to use any photographs, video tapes, motion pictures,recordings or other record of the event for any reasonable purpose. I understand that my entry is non-refundable.
______________________________________________________________________