Street_________________________________________________________________
AGE_______ Birthday _____/_____/_____
Mon Day
Year
City___________________________________
ST__________ ZIP_______________ HTC Member
Yes No
Home Phone_________________________ Work
Phone_____________________ T-shirt size:
S M L
XL
School if paying student fee:__________________________________
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 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