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Toad Suck 10K / 5K Entry Form
May 3, 2008 -- 8:00am
-- Conway, AR
*** John McConnell Stadium at Conway
High School West. *** |
Name
Last:
First: |
Birthdate:
Sex:
Age on 5/3/2008: |
Address: |
City, State, Zip: |
Shirt Size:
M
L XL
|
Phone
Day:
Evening: |
Division: 10K Run
10K Wheelchair
5K Run/Fun 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 Toad Suck Daze Festival, Regions Bank, the Conway Running Club,
the
City of Conway, the County of Faulkner, 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 Toad Suck Daze Run and mail to:
Toad Suck Daze Run
c/o Regions Bank/Run
P. O. Box 279, Conway, AR 72033
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Fees: $20
if received by April 30, $25 after May 1 and day of race
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For more information call 501-450-4786 or
email toadsuckrun@conwaycorp.net
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