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Panther 5K Kick Off Classic
Entry Form
September 10, 2011 --
8:00am -- Benton, AR
Benton Athletic
Complex on Benton Parkway
Map |
Name:
Last:
First: |
Date of Birth:
Sex: M F |
Address: |
City, State, Zip: |
Shirt Size: S
M L
XL
Age on 09/10/2011: |
Email address: |
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 Panther 5K Kick Off
Classic, Benton Public Schools,
the City of Benton, the County of Saline, 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 Benton Panther Foundation and mail to:
Benton Panther Foundation
500 River Street
Benton, AR 72015
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Fees:
$20 if received by September 3
$25 day of race
$15 for youth 12 & under
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