Street_________________________________________________________________
AGE_______ Birthday _____/_____/_____
Mon Day
Year
City___________________________________ ST__________
ZIP_______________ HTC Member
Yes No
Home Phone_________________________ Work
Phone_____________________ T-shirt size:
S M L
XL
Race
Waiver: I, individually, (and/or as parent, and/or
guardian of the named minor) for and in consideration of acceptance of this
entry in the aforementioned event, do hereby release, remise, waive, and
forever discharge the Road Runners Club of America, Huntsville Track Club and
any and all other supporting groups of this said racing event, together with
all their officers, agents, officials and employees, from any and all
liability, claims, demands, actions, or causes of action whatsoever arising out
of, or relating to any injury, illness, loss, or damage, including death,
relating to participation in the aforesaid event. I further state I am in proper physical
condition to participate in this event. In addition, I agree that my
participation in this event requires that I will not participate with roller
blades, baby joggers, skateboards, animals, headphones, or anything which the
race director deems dangerous to myself or other participants and that the race
director may remove me from this event for a violation of said policy. I further grant permission to this race and
the organization conducting the race and/or agents authorized by them to use
any photographs, videotapes, motion picture, recordings and any other record of
this event for any purpose. I also agree
that if the event is cancelled for any reason that all entry fees are non‑refundable
and that this entry is non-transferable.
Signature: _____________________________________________Date:
_____________________
Parent/Guardian Signature if under
19:_________________________________________________________
Official Use Only
Race Number Paid