First Name:

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                                     Gender: Select One Male Female

                         Date Of Birth:

                 Age On March 4th:

                       Check This Box For Baby Jogger Baby Jogger

Check This Box If You Are A Member Of A Team Team Member (Teams of 6 or more)

Team Name Or Military Command: (If Applicable)

                                         T Shirt Size: Select One Medium Large Extral Large

Waiver and Release of Liability 

In consideration for my participation in the 14th Annual Seabee 5K Run to be held at Naval Station Pearl Harbor, HI on 04 March 2006, I, the undersigned, intending to be legally bound, do hereby for myself, my heirs, my executors and administrators; forever waive, release and give up any and all claims, demands, liability, damages, costs and expenses of any kind whatsoever (including personal injuries and wrongful death) against the Seabees, Naval Station Pearl Harbor, the United States Navy, the Department of Defense, the Morale Welfare and Recreation Department, their directors, employees, representatives, agents, contractors, subcontractors and volunteers, from any and all rights, claims or liability for any and all personal injury or illness, wrongful death, property damage and property loss incurred or caused by me or to me or anyone else out of or in connection with my participation in the Seabee 5K Run. I attest and verify that I have full knowledge of the risks and danger involved in the Seabee 5K Run, and agree that I will defend, indemnify and hold harmless the U.S. Government, Naval Station Pearl Harbor, it's agencies, instrumentalities (including MWR), their members, officers, and volunteers from all claims, demands or causes of action, including court costs and attorney's fees directly or indirectly arising from any or other proceedings brought by or prosecuted for my benefit contrary to this agreement. This release extends to all claims of any kind and nature, whatsoever known or unknown, and I expressly waive any benefits I may otherwise have, under the Civil Code of the state of Hawaii relating to the above. I certify that I am in good health and able to participate in the Seabee 5K Run.

                               Agree To Waiver: Select One Yes

                                          Signature: (Parent/Guardian if under 18)

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