Address:

                          City:

                        State:

                            Zip:

                       Phone:

                     E-Mail:

  Age On Race Day:

                    Gender: Select One Female Male

             T-Shirt Size: Select One Small Medium Large X Large

Where did you hear about event:

Waiver of Participation

Waiver: In consideration of the acceptance of my entry, I, for myself, my executors, administrators and assigns do hereby release and discharge the “helluva run” run, the Boy Scouts of America, its agents, representatives or affiliates, and any and all other sponsors jointly and severally, for any and all claims of injuries or damages incurred by me as a result of or in connections with said event. I attest and verify that I have full knowledge of the risks involved in the event and am physically fit and trained to participate in this event. (caution! be aware there will be vehicle traffic on the roads at all times)

          Agree To Waiver: Select Yes

    Participant Signature:

    Signature above must be signed by parent or guardian if under 18

 

   Online Registration Is Now Closed