FIRECRACKER RUN REGISTRATION FORM       WEDNESDAY, JULY 4, 2012

WAIVER. Knowing that running a road race is a potentially hazardous activity, I enter and run this race certifying that I am medically able and properly trained. I also know that, although police protection will be provided, there may be traffic on the course route. I assume the risk of running in traffic. I also assume any and all other risks associated with running this event including but not limited to falls, contact with other participants, the effects of weather, including high heat and/or humidity, and the condition of the roads.

Knowing these facts, and in consideration of your acceptance of my entry, I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue, and waive, release. and discharge the Excelsior Area Chamber of Commerce, all paying sponsors, and any other organization associated with the race, and with the local government and police, volunteers, and any and all sponsors including their agents employees, assigns or anyone acting for or on their behalf, from any and all claims or liability for death personal injury, or property damage of any kind of nature arising out of, or in the course of, my participation in this event. This release extends to all claims of every kind of nature whatsoever, foreseen or unforeseen, known or unknown.

The undersigned further grants full permission of this race and any organization conducting the race and/or agents authorized by them to use any photographs, videotapes, motion pictures, recordings, or any other record of this event for any purpose.

I have read the foregoing and certify my agreement by my signature below.

Signature
(by parent or guardian if
participant is under 18) ___________________________________________________

MAIL ENTRY FORM WITH $28 (10K) OR $5 (2 MILE) BY JUNE 28 TO

Make check payable to FIRECRACKER RUN

MORE INFORMATION

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