First Name:

                  Address:

                        City:

                       State:

                           Zip:

                     Gender: Choose One Male Female

               Birth Date:

  Age On Event Day:

                       Phone:

                        Email:

                         Event:   Select One 5K Run

                   Shirt Size: Choose One X Small Small Medium Large XX Large XXX Large We will try to accommodate shirt size but it is not guaranteed?

LIABILITY WAIVER:

I know that running a road race is a potential hazardous activity. I should not enter or run/walk unless I am medically able and properly trained. I agree to abide by any decision of all race officials relative to my ability to safely complete the run. I assume all risks associated with running in this event including, but not limited to falls, contact with other participants, the effects of the weather, traffic and the conditions of the road and trail. With 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 in my behalf, waive the release of Wyoming Township, Kent County, and any/ all participating sponsors, their representatives and successors from all claims and liabilities of any kind arising out of my participation in this event. I grant all permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for ANY legitimate purpose. The event director has the right to cancel this event in the case of severe weather. Registration fees are non-refundable and non-transferable.

  
                                          Waiver: Choose One Yes

                                      Signature:

Parent Or Guardian If Under 18:

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