First Name:

        Address:

               City:

             State:

                Zip:

            Email:

           Phone:

Age On Race Day:

                     Event:  Select Event 5K Run 5K Walk

Waiver & Release: I hereby affirm that I have been well advised and thoroughly informed of the inherent hazards and policies of the event. I know that participation in the 5th Annual Kenyon 5K Run/Walk is a potentially hazardous activity. I should not participate unless I am medically able. I hereby personally assume all risks associated with my voluntary participation in this event for any harm, injury or damage that may befall me as a result of my participation, whether foreseen or unforeseen, including but not limited to heat or cold related incidents. I understand and agree that neither the City of Kenyon, nor any of the sponsors of the event may be held liable in any way for any occurrence in connection with my participation in the 5th Annual Kenyon 5K Run/Walk that may result in injury, death, or any other damages to me or my family, heirs or assigns, and in consideration of being allowed to participate in this event. I understand and agree that all entry fees are nonrefundable and nontransferable. Further, I acknowledge and agree that the 4th Annual Kenyon 5K Run/Walk, in it’s sole discretion, may delay or cancel the event if it believes the conditions on the race day are unsafe. In the event that the event is delayed or cancelled for any reason, including but not limited to fire, strike, protest, labor difficulty, work stoppage, insurrection, war, public disaster, flood, unavoidable casualty, acts of God or the elements (including without limitation, rain, snow, ice, hail, high winds, thunderstorms, lightening, tornado, earthquake, or any other cause beyond the control of the City of Kenyon, there shall be no refund of the entry fee or any other costs of the entrant in connection with the events. I hereby personally assume all risks in connection with said event for any harm, injury or damage that may befall me, including all risks connected therewith, whether foreseen or unforeseen; and further to save and hold harmless said event and persons from any claim by me or my family, estate, heirs, or assigns arising out of my participation in this event. I further state that I am of lawful age and legally competent to sign this affirmation and release, or that I have acquired the written consent of my parents or guardians; that I understand the terms herein and contractual and not a mere recital; and that I have signed this document of my own free will. It is my intention by this instrument to exempt and release the City of Kenyon, and all event sponsors from all liability whatsoever for personal injury, property damage or wrongful death arising out of or in the course of my participation in the event.

Agree With Waiver: Select Yes

                Signature:   (Parents Signature required if under 18)

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