Saturday, September 14, 2013 -- Mount Zion, WV / Calhoun County Park, Mt. Zion, WV
Calhoun Days 5k Trail Run
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RACE CONTACT: Amy Nicholas (Phone) 304-354-9335, (email) ajnicholas@access.k12.wv.us
Fee:$15.00 pre-registration fee (first 30 registrants guaranteed a performance t-shirt) by 9/1/13. $20.00 after 9/1/13
Make checks out to: Calhoun County Park
Mail form/payment to: Calhoun County Park, PO BOX 276, Grantsville, WV 26147
Last Name: ____________________________________________________________
First Name: ___________________________________________________________
Address: ______________________________________________________________
City: _________________________________________________________________
State: _________________________ Zip: _________________________
Phone: (__________________)____________________________________
Email: ________________________________________________________
Emergency Contact Name: _______________________________________________
Phone: (__________________)____________________________________
Age: ______ Date of Birth (mm/dd/yy): _____/_____/_____ Gender: __Male __Female
Age Division (check one): 14/under___ //15-19___ //20-29___ //30-39___ //40-49___ //50-59___ //60+___
T-Shirt Size (check one): Small___ //Medium___ //Large___ //Extra-Large___ (Only First 30 registered and then based on availability.)
WAIVER: I know that running 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 the risks associated with running in this event including, 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 these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Calhoun County Park and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I grant permission in this event to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. All forms must be signed. Incomplete or unsigned forms will not be accepted.
Signature _______________________________________________________________________
Date _________________________________________________
Signature of parent/guardian if entrant is under 18:
Signature _______________________________________________________________________
Date _________________________________________________