Saturday, October 31, 2009 -- Charleston, WV / Kanawha State Forest
Holz Elementary PTA Trick or Trot 5K Race/1 Mile Walk
PLEASE PRINT
Name__________________________________________________________ Sex_____ Age______
Address___________________________________________________________________________
City______________________________________________ State_______Zip Code___________
Please check one: Run____ Walk____ Wheelchair____
T-Shirt size, check one: Med____ Large____ XLarge____ XXLarge____
WAIVER (If under 18 years of age, your Parent or Legal Guardian must read and sign waiver.) I know that participating in a run/walk is a potentially hazardous activity. I should not participate unless I am medically able. I understand the nature of and assume all risks associated with my voluntary participation in this event including, but not limited to falls, contact with other participants, the effects of the weather and traffic. Knowing these facts, I, the undersigned waive and release for myself and anyone entitle on my behalf, any and all rights and claims for damages, demands and any other actions whatsoever which I may have against Holz Elementary PTA and Kanawha State Forest, volunteers and all participating sponsors and supporters of the event. I grant full permission to use any photographs, video tapes, or any other record of my participation in this event for any legitimate purpose including promotional purposes.
Signature________________________________________________________________
Date______________________________