----------
Chilly Cheeks 10K Entry Form
January 13, 2018 -- 8:00am -- Camden, AR
Race starts at Camden Municipal Airport
Name:
Last:                                                                     First:

Date of Birth:                           Sex:      M     F                   Age on 1/13/18:

Address:

City, State, Zip:

Shirt Size:      
Adult -   S   M   L   XL   XXL  


Circle One:         10K Run          10K Walk


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 Chilly Cheeks 10K, the city of Camden, Arkansas Runner LLC, 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
Camden Rotary Club 10K
Mail to:
Chilly Cheeks 10K
c/o Tommy Raines
140 Darnell Street
Camden, AR  71701


Fees:
$30 pre-registered by 1/6/2016, $35 after including day of race.
T-shirts guaranteed only for pre-registered entries.
Registration and packet pickup begin at 7:15am on day of race

Overall male/female runner prize is $100
For information, call 870-836-6462 (day) or 870-231-5913 (evening)
Email drjtraines@gmail.com