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Friday, June 29, 2007 -- Charleston, WV / Haddad Riverfront Park
Independence Day Celebration Race (iPO Event Id#: 10102) - Return to the Details Page

Make Checks payable to/ Mail registration to:
Charleston Parks & Recreation, 200 Baker Lane, Charleston, WV 25302




Phone:_________________________ Email:__________________________

Please check all that apply: Male___ Female____ 5-K Run___ 2MileWalk___

Age Division/CIRCLE ONE: Wheelchair, 19 and under, 20"29, 30"39, 40"49, 50"59, 60+

Shirt Sizes - Youth: Med___ Adult: Small___, Med___, Lg___, XL___, 2XL___

Waiver: I, the undersigned, waive and release myself, my heirs, executors, and administrators, any and all rights and claims for damages, demands, and any other actions whatsoever, which I may have against all participating sponsors and supporters and The City of Charleston, arising out of my participation in this event, including and all injuries, including death suffered me as a result of my participation in this event. I consider myself adequately trained for the completion of this event. Should I suffer an injury or illness, I authorize officials of this event to use their discretion to have me medically treated and transported to a medical facility. I also authorize the sponsors to use any photographs or video taken of me to be used in any promotional materials.


____________________________________________________________ Parent/ Guardian Signature Required Under 18 years of Age

Date: ___________________________________