First Name:

                   Address:

                          City:

                        State:

                           Zip:

                      Phone:

                       Email:

                          Age:

                           Sex:   Select One Female Male

                        Event:   Select One 5K 2 Mile

           Fee Category:   Select One 14 Years Old And Under 15 Years Old And Over

                  Shirt Size:   Select One Small Medium Large XL XXL

MANDATORY RELEASE. Please Read Carefully and sign. I acknowledge and agree that:

1. Participation in or attendance at the Dolores River Festival 5K or 2M Fun Run Event (“Event”) involves inherent risks and dangers of accidents, personal and bodily injury (including death) and property loss or damage. These may result from my own actions or inactions, as well as the actions or inactions of others, the rules of play, and the condition of the facilities, equipment, and vehicles. Further, there may be other risks not known to me and not reasonably foreseeable at this time. I have considered the nature and extent of the risks involved and I voluntarily choose to assume all such risks, both known and unknown, even those risks that result from the negligence of the Released Parties (defined below) or others, and assume full responsibility for my participation in the Event; I consent to treatment in the event of an emergency or other incident in which, in the reasonable judgment of the on-site personnel, I require medical care.

2. I understand that the Event may be photographed, videotaped, or otherwise recorded, and I agree that the Dolores Rotary Club (“Club”) may use my name and likeness (in any form and without regard to distortions of character, form or color, or any other alteration) in photographs, videotapes, audiotapes, and other media, without any additional consideration to me or to any third party. I, for myself and on behalf of my heirs, estate, insurers, successors and assigns, hereby release, indemnify and hold harmless Club, its affiliates, its officers, directors, shareholders, employees, agents and representatives, and the successors, assigns, and insurers administrator of the Event, (collectively, the “Released Parties”), with respect to any and all claims or causes of action (including attorney fees), I may have for damages for personal or bodily injury, disability, death, loss or damage to person or property, whether arising from the negligence of any or all of the Released Parties or otherwise, to the fullest extent permitted by law. This release includes claims that may arise during transportation to and from the Event, and I acknowledge that such transportation is solely my responsibility to arrange and obtain.I have read this Release, fully understand its terms and understand that I am giving up substantial rights by signing it. I sign this Release freely and voluntarily, without any inducement or coercion. of such entities, and event sponsors [list here], and any consultant, sponsor, advertiser, organizer, volunteer, volunteer organization, contractor, subcontractor or

Agree With Release:   Select Yes I Accept Release

                  Signature:   (Type In Name)

Parent or Guardian Must Sign If Under 18

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