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Run for the Son 5K
Entry Form
April
24, 2010 -- 8:00am --
Kibler, AR |
Name:
Last:
First: |
Date of Birth:
Sex: M F
Age on 4/24/10: |
Address: |
City, State, Zip: |
Email address: |
Shirt Size:
S
M
L
XL
XXL |
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Circle One:
5K Run 5K Walk
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Release:
I
hereby waive and release any and all rights and claims for damages which I
may have against the Kibler United Methodist Churchl, ArkansasRunner.com,
as well as promoters, other participants, operators, officials, any person
in a restricted area, sponsors, advertisers, owners and leasees of
premises used to conduct the event and each of them, their officers and
employees, all for the purposes herein referred to as “releases”, from all
liability to the undersigned, his personal representatives, assigns, heirs
and next of kin for any and all damages and any claim or demands therefore
on account of injury to the person or property or resulting in death of
the undersigned, whether caused by the negligence of the release or
otherwise while the undersigned is in or upon the restricted area, and/or,
competing, officiating in, observing, or working for, of for any purpose
participating in the event. I further agree to hold harmless
ArkansasRunner.com, the Government, its officers, agents, and employees
for any damage to my personal property or me caused as a result of my
participation in this event. I further understand that I am responsible
for all dependents and authorized guest who accompany me while
participating in this event. |
Signature:
Date: |
Parent Signature if under 18 years:
Date: |
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Make checks payable to Kibler UMC 5K and mail to:
Kibler UMC
19 East Kibler Highway
Alma, AR 72921
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Fees:
$15 Pre-registered, $20 day of race
Shirts only guaranteed for registration by April 9, 2010
For
information, call 479-601-5530 or 479-461-7166 |
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