Name
Address
City State Zip
Telephone Number
First 200 Adult T-Shirt Size 1. 2.
Name(s) of all participants
Age of all participants 1. 2. 3. 4.
Total Enclosed:
($20 Per Person and $50 For a Family of 3, $5 for each additional person)
Waiver of Liability:
In consideration of the acceptance of this entry into the Christian Family Services, Inc. Family Fit and Fun Run 5K /1 mileWalk to occur on November 5th, 2011 (the "Event") I, the undersigned, for myself and on behalf of any other minor persons (the "Minors") for whom I have by signing below given permission to participate in the Event, intending to be legally bound, hereby, for myself, for the Minors, and for my and the Minors' heirs, executors, and administrators, waive and release any and all rights and claims for damages or otherwise that I or the Minors may have against any of the persons or entities involved in the organization or sponsorship the Event (including but not limited to the City of Webster Groves, Ghisallo, all sponsors of the Event, and any persons working for or volunteering for any such entities) arising out of my or the Minors' participation in the Event, even though that liability may arise out of negligence or carelessness on the part of the persons or entities named in this waiver. For myself and on behalf of the Minors, I/we agree to abide by any decision of a race official relative to my/our ability to safely complete the Event; I/we assume all risks associated with participating in the Event, including but not limited to falls, contact with other participants, the effects of weather, traffic, and the conditions of the course, all such risks being known and appreciated by me; I attest and verify that I/we will participate in the Event by running or walking, that I/we am/are physically fit and sufficiently trained for the completion of the Event, and that my/our physical condition has been verified by a licensed Medical Doctor; I hereby grant full permission to any and all of the aforementioned parties to use for any legitimate purpose my/our name(s), likeness(es), and voice(s), as well as any photographs, videotapes, motion pictures, recordings, or any other record of the Event in which I/we may appear; and I waive any right to refund of any registration fee for any purpose, including my/our failure to participate or cancellation of the Event. I also understand that by filling out the registration, and paying my registration fees, I am hereby agreeing to the Waiver for myself, and on behalf of any other minor person(s) for whom I have registered.
By signing the mail in application, I agree to the terms and conditions of the Waiver.
Signature of Adults: 1. 2.
Date:
