Saturday, August 16, 2008 -- Hurricane, WV
Run For The Health Of It ENTRY FORM
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Mail entry form and fee to:
T.O.P "Run For The Health OF It" // Attn: Charley Bowen
2368 Thompson Rd., Culloden, WV 25510.
Name: _____________________________________________________
Address: __________________________________________________
City: ______________________________State: ____Zip: _______
Phone: ____________ Age on 08/16/08:_____circle Male Female
Choose T-shirt size: (check one) S___ M___ L___ XL___ 2X___
Choose Event: 5K Run______ or 1 Mile Walk______
Waiver and Release of Liability: Please carefully read the following waivers and release of liability, then sign. For those younger than 18 years of age, a parent or legal guardian must provide his/her signature. Unsigned forms will not be accepted. In consideration of acceptance of this entry, I waive all rights and claims for damage that I may have against Valley Park, City of Hurricane, Hurricane High School, Putnam County Youth Wellness Task Team and all sponsors. I attest that I am physically fit and have trained for this event.
Signature________________________________________________ Date_______________
Parent/Guardian__________________________________________ Date_______________