Skippack Lions Fun Run Form


Registration Form WAIVER & RELEASE
(Each Runner/Walker must complete this form, print & mail in)

Please fill in the information below

Your Name
Email Address
Phone
Street Address
City, State, Zip
Gender
Age on 6/21/2008
Please Select One
T-Shirt Size
Dri-release T-shirt avail to all pre-reg by 6/15/08 for an additional $10.00.
How did you hear about the race?

Entrants please read and make sure you thoroughly understand this waiver before signing.

In consideration of being permitted to participate in the Lions 5k & 1Mile Fun Run, I, the undersigned intending to be legally bounded hereby for myself, my heirs, executors, administrators and personal representatives, hereby waive and release any and all rights and claims for damages, illness, injuries, or losses which I have or may have or which may occur to me against all race officials and all organizations conducting or involved in this event, including but not limited to Skippack Lions Club, Township of Skippack or Lower Salford, and any and all of their employees, agents, representatives, successors and assigns, that may result from my participation in said event. I am in excellent health and in proper physical condition to participate in said event. Further, I hereby grant full permission to the aforementioned persons or organizations to use my e-mail, name and/or picture in newspaper, videotape, or any other record or account of the event for any purpose whatsoever.

Do You Agree?
Please Sign ___________________________________________
Parent/Guardian Agree? (Parent Guardian Signature if under 18, parent must be at the event for sign up)
Parent/Guardian Sign ___________________________________________

Once you've printed please...
Sign & Mail Non-refundable checks or money orders to:

Skippack Lions Club
c/o Krantz Family Chiropractic
4088 Skippack Pike PO BOX 159
Skippack, PA 19474

Comments:

(optional)
 

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