Street Address: _________________________________________________________________________________________
City/State/Zip Code: _____________________________________________________________________________________
Gender (Circle One): Male Female Age on October 5th: ___________________________________________
Are you (Circle One): Running Walking How did you hear of the Race? ____________________________
T-Shirt Sizes (Circle One): S M L XL
WAIVER I know that running/walking is a potentially hazardous activity. I should not enter or run/walk this event 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/walk. I assume all risks associated with running/walking in the race including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity and/or the conditions of the trail; all such risks being known and appreciated by me. All fees are nonrefundable. Race will take place rain or shine. In the event of extreme weather conditions or some other unforeseen act of God that may prohibit the race, all fees are nonrefundable. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release the event, and all sponsors, their representatives and successors 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. Registration will not be accepted without acknowledgment of waiver signature.
Signature: ________________________________________________________ Date: ____________________________
Parent or Guardian Signature is required if participant is younger than 18 years of age