First Name:

            City:

          State:

             Zip:

        Phone:

         Email:

Age On Race Day:

               Shirt Size:            Select One Small Medium Large X Large

              Entry Fee:   Select One Adult Children 12 and under

Runner’s Agreement, Waiver Release and Acknowledgement I know that running/walking a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete this run. I assume all risks associated with this event, but not limited to: Falls, contact with other participants, the effects of weather, including water, ice or snow on the road, traffic and the conditions of the road, all such risks, being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of you accepting my entry, I for myself and anyone entitled to act on my behalf, waive and release The Harrisonburg Education Foundation and the City of Harrisonburg from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for legitimate purpose.

    Waiver: Select Yes

Signature:            (parent or guardian if under the age of 18)

 

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