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Child Abuse Awareness 5K
April 12, 2008 --
8:00am
Pine Bluff Arsenal, AR -- Race begins at PBA
Fitness Center crosswalk |
Name: |
Address: |
City, State, Zip: |
Birthdate:
Age on 04/12/2008: |
Shirt Size: S
M
L
XL
XXL
Sex: M F |
Circle One: 5K Run
2 Mile 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 Child Abuse Awareness 5K, the Pine Bluff
Arsenal, 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 IMWRF and mail to:
Pine Bluff Arsenal
AMSCM-OPPB-PAR
Attn: Carla Easterling, Bldg. 16-310
Child Abuse Awareness 5K
Pine Bluff, AR 71602
For information:
Jerry Pye at 870-540-3588 or Carla Easterling at
870-540-3779 |
Fees: $20 pre-registered,
$25
day of race
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