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River City 5K Entry Form
July 16, 2011 -- 7:30am --
North Little Rock, AR --
Burns Park Soccer Complex
Click here for online registration |
Name:
Last:
First: |
Date of Birth:
Sex: M F
Age on 7/16/11: |
Address: |
City, State, Zip: |
Shirt Size:
YS YM
YL AS AM
AL AXL AXXL
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Circle One:
5K Run 5K
Walk Spirit Runner
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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 River City 5K race, the city of
North Little Rock, 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 River City Ministry Run Walk and mail to:
P. O. Box 251703
Little Rock, AR 72225
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Fees:
$15 through
7/13/11, $20
after
Family registration below requires separate form for
each person.
Families of 4 pre-registration - $50 with $10 additional each child (in
same household)
Race day, family of 4 - $70 with addition $10 per child
For information:
501-658-1644 -
bobestes@att.net or
jim@rivercityministry.org
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