Age on 9/23/2017
Date of Birth (mm/dd/yyyy)
Shirt SizeAdult X SmallAdult SmallAdult MediumAdult LargeAdult X LargeAdult XX LargeAdult XXX Large-------------------------Youth MediumYouth Large
Release and Waiver: By indicating your acceptance, you understand, agree, warrant and covenant as follows: By signing this Release and Waiver, I, for myself, (or as a parent or guardian of child participating, if under 18 years of age), acknowledge that running a road race is a potentially dangerous activity, and that there are risks involved in participating. I (or my child) should not enter or run unless I am (or my child is) medically able and properly trained. I (for myself, and for my child, if participating) certify as a material condition to my being permitted to enter this race that I (or my child) am physically fit and sufficiently trained for the completion of this event. I (or my child) agree to abide by all rules and any decision of a race official relative to my (my child's) ability to complete the run safely. I (for myself, and for my child, if participating) assume all risks associated with participating in this event, including, but not limited to: falls, contact with other participants, the effects of the weather, including rain and high temperatures, and traffic and road conditions, such being known and appreciated by me. Having read and understood this Release and Waiver and in consideration of you allowing me (my child) to participate in the Tony Pope Memorial 5K Run/Walk (hereafter, "Road Race"), I hereby release Cargo Transporters, Inc., its parent and sister companies, all employees, agents, and representatives of same, as well as all Road Race sponsors and Big Kahuna Timing from any and all claims and liability of any kind arising out of or related to my (my child's) participation in the Road Race, thereby waiving my rights to any such legal claims I might otherwise have had. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees. I grant permission to all of the foregoing to use photographs, video recording, or any other record of this event for any legitimate purpose, including, but not limited to, race result publication and/or publicity opportunities.
I have read and agree to the Release and Waiver printed above.
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