Saturday, May 21, 2011 -- Morgantown, WV
New Balance Girls on the Run 5K ENTRY FORM
Return to the Details Page
RACE CONTACT: Jeanette Custer (phone) 304-657-0305
Entry Fee:
$15 BY Friday, May 13, 2011, $20 AFTER May 13 and on race day (from 2:00 pm - 4:00 pm)
Check Enclosed - Make payable to: Mon General Hospital
Mail to: GOTR of Mon County, 364 Patteson Drive #161 Morgantown WV 26505
PLEASE PRINT
First Name:______________________________________________________________
Last Name:_______________________________________________________________
Address:_________________________________________________________________
City/State/Zip:__________________________________________________________
Phone: (_________________) ______________________________________________
E-mail:__________________________________________________________________
Age (as of May 21, 2011): ________ // Male_______ or Female_____
GOTR Coach: _______ // GOTR Participant: _______
T-Shirt Size: S_____ M_____ L_____ XL_____ XXL_____
Child Size T-Shirt: S_____ M_____ L_____
WAIVER: I know that running or walking a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event but not limited to fall, contact with other participants, the effects of weather, including high heat and/or humidity, traffic and other conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing those facts and in consideration of your accepting my entry, I for myself and anyone else entitled to act on my behalf, waive and release the Girls on the Run of Monongalia County organization and all sponsors, their representatives and successors from all claims in liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion picture recordings or any other record of this event for any legitimate purpose.
SIGNATURE:_______________________________________________________________
* Parent or Guardian MUST sign if participant is under 18 yrs
DATE:_________________________________