Team Member 1 And Age: Example; Gary Smith 41
              T Shirt Member 1:                  Choose One Small Medium Large X Large

Team Member 2 And Age:
              T Shirt Member 2:                  Choose One Small Medium Large X Large

Team Member 3 And Age:
              T Shirt Member 3:                  Choose One Small Medium Large X Large

Team Member 4 And Age:
              T Shirt Member 4:                  Choose One Small Medium Large X Large

Team Member 5 And Age:
              T Shirt Member 5:                  Choose One Small Medium Large X Large

Team Captain Information:

                   Captain Name:

                   Captain Phone:

                             Address:

                                    City:

                                  State:

                                     Zip:

                                 Email:

Please note: To participate in the race, each team member must provide a signed release agreeing to the terms of the following conditions. Print out and bring the signed waiver to pre-registration or to the event.  You  must have the form completed and turned in prior to event start.

*EACH participant must provide a signature to certify the following statement (Parent must sign if runner is under 18 years old):  Full Waiver & Release: In consideration for my entry being accepted, I hereby waive and release forever for myself, for my heirs, executors, administrators, any & all claims of actions & suits I may accrue against the Porterville Breakfast Rotary, City of Porterville, County of Tulare, property owners on whose property the race is run, race director, volunteers and any sponsors of this race for any bodily injury, property damage or economic loss, including death, suffered by me while traveling to and from or competing in the Porterville Cancer 5K run or 5K Walk on May 3, 2008 whether from natural hazards, human-made or any other defect or omission or act.

To Print Form Click Here (opens in new window)

                              Waiver:                  Choose One Yes To Waiver I understand that the release must be signed by each Team member and returned prior to participating in the event.  Print out and bring the signed waiver to pre-registration or to the event.  You  must have the form completed and turned in prior to event start.

 

Online Registration Is Now Closed
 

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