BIRTHDATE _______ MALE ____ FEMALE____CIRCLE ONE: ½ Marathon WAVE 1_____ WAVE 2_______ 4M Relay
TEAM NAME IF RELAY TEAM__________________________3-person relay_____ OR ADA Relay_______
LAST NAME_________________________ FIRST NAME ____________________________
DAY PHONE_______________________NIGHT PHONE__________________
EMAIL__________________________________ T-SHIRT SIZE: _________XS_______S____M____L____XL_____XXL
I understand that participating in this event is potentially hazardous, and that I should not enter and participate unless I am medically able and properly trained. In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or accident which may occur while I am traveling to or from the event, during the event, or while I am on the premises of the event. I also am aware of and assume all risks associated with participating in this event, including but not limited to falls, contact with other participants, effect of weather, traffic, and conditions of the road. I, for myself and my heirs and executors, hereby waive, release and forever discharge the event organizers, sponsors, promoters, and the event, for all liabilities, claims, actions, or damages that I may have against them arising out of or in any way connected with my participation in this event. I understand that this waiver includes any claims, whether caused by negligence, the action or inaction of any of the above parties, or otherwise. I understand that the entry fee is non-refundable and non-transferable. I hereby grant full permission to any and all of the above parties to use any photographs, videotapes, motion pictures, website images, recordings or any other record of this event that I may appear in.
SIGNATURE__________________________DATE______________(Parent must sign if applicant is under 18)