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Fordyce on the Cotton Belt 5K
April 26, 2008 -- 8:00am -- Fordyce, AR |
Name: |
Address: |
City, State, Zip: |
Birthdate:
Age on 04/26/2008: |
Shirt Size: S
M
L
XL
Sex: M F |
Release:
I know that running and volunteering to work in club races are potentially hazardous
activities. I should not enter and run in this race 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 and
volunteering to work in club races including, but not limited to falls, contact with other
participants, the effects of the weather, including high heat and/or humidity, the
conditions of the road and traffic on the course, all such risks being known and
appreciated by me. Having read this waiver and knowing 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 Fordyce on the Cotton Belt Festival, ArkansasRunner.Com and all sponsors, their
representatives and successors from all claims or liabilities of any kind arising out of
my participation in the race and/or club activities even though liability may arise out of
negligence or carelessness on the part of the persons named in this waiver. I grant
permission to all the foregoing to use any photographs, motion pictures, recordings, or
any other record of this event for any legitimate purpose. |
Signature:
Date: |
Parent Signature if under 18 years:
Date: |
Make checks payable to Fordyce on the Cotton Belt and mail to:
Fordyce Chamber of Commerce, 119 West Third Street, Fordyce, AR 71742
For information:
870-352-3595, 870-352-3520, 870-352-5125,
broadjb@alltel.net |
Fees: $15 in advance, $20 race day
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