WAIVER & ENTRY FORM – Doc & Mardie 5K road race August 19, 2007

 

WAIVER & ENTRY FORM – Doc & Mardie 5K road race August 19, 2007

 

I know that running 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 the run. I assume all risks associated with running this event including, but limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and know these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Central Maine Striders Club, City or Town officials, race directors and all sponsors, their representatives and successors for 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 name in this waiver.  

 

Name: ________________________________________________________

 

Age: _____                                          Gender: _____

 

Address: _______________________________________­­­­­­­­­­­­­­­­­­­­­________________

 

Signature:_______________________________________________________

 

Parent/Guardian if Under 18 signature:________________________________

 

How did you hear about the Doc & Mardie 5K road race? ___________________

 

__________________________________________________________________

 

Mail to: Alfond Youth Center – 126 North Street – Waterville, ME 04901