First Name:

        Address:

               City:

             State:

                Zip:

            Email:

           Phone:

Age On Race Day:

                     Event:      Select Event 5K Run 5K Walk

Accident waiver and release of liability: Release of name and likeness I know that running/walking a race is a potentially hazardous activity. I certify that I am physically fit have sufficiently trained and prepared for participation in the event and have not been advised otherwise by a qualified medical person. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I hereby consent to receive medical attention which may be deemed advisable in the event of an injury, accident and/or illness during this event. I understand that all evacuation and medical costs for participants and volunteers will be borne by that person or their heirs. The race organizers and sponsors are in no way liable or responsible for medical costs or emergency evacuation. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I hereby take action for myself, my heirs, executors, next of kin, administrators or anyone else who might claim on my behalf, waive and release, The Following Entities or Persons: Vallaree Rudd, all involved municipalities or public entities (and their respective agents and employees) the event holders, the event sponsors (and their directors, officers, volunteers, representatives and agents), event volunteers and event directors, from all claims or liability for death, personal injury, or property damage of any kind or nature whatsoever arising out of, or in the course of, my participating in this event whether same be caused by negligence or fault. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown and I indemnify and hold harmless the entities or persons mentioned in this paragraph from any or all liabilities or claims made by any other individual or entities as a result of my actions during this event. Parent or Guardian waiver for minors (under 18-years old) if applicable. The undersigned parent and natural guardian or legal guardian does herby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all parties referred to above from all liability, loss, cost, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to act and release said parties on the behalf of the minor and the parents or legal guardian. Minors accepted only with a parent or guardian’s signature.

Agree With Waiver: Select Yes

                Signature:        (Parents Signature required if under 18)

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