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March of Dimes Run Before
They Can Walk 5K Entry Form
April 28, 2012 --
7:30am --
Clinton Presidential Center, Little Rock, AR
Online Entry |
Name:
Last:
First: |
Date of Birth:
Sex: M F
Age on 4/28/12: |
Address: |
City, State, Zip: |
Drawstring bags and water bottles in lieu of shirts |
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Email:
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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 March of Dimes Run
Before They Can Walk 5K, the city of
Little Rock, the
County of Pulaski, 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: |
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Make checks payable to March of Dimes and mail to:
Natalie Hedrick
March of Dimes
1501 North Pierce, Suite 106
Little Rock, AR 72207
Online Entry
Packet pickup at Go!
Running on April 27, 2012, noon to 6:00pm
Race day registration and packet pickup, 6:00am to 7:00am |
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