Address:

                          City:

                        State:

                            Zip:

                       Phone:

                     E-Mail:

  Age On Race Day:

                    Gender: Select One Female Male

                      Event: Select One 5K Mile Fun Run

 T-Shirt Size / Mug: Select One Small Medium Large X Large XX Large Childs Small Childs Med Childs Lg Thermal Mug

Waiver of Participation

Liability Waiver: I acknowledge that a running race event is a potentially hazardous activity and I should not enter unless I am medically able and properly trained. I assume the risks of participating in the 1st Annual DVA 5K run & 1 Mile Walk , but not limited to: falls, contact with other participants, the effects of the weather, traffic on the course, all such risks being known and appreciated by me. Having read this waiver, and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release all governments, event sponsors, volunteers and professionals associated with this event or localities in which segments of events are held from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.