STRIVE Wellness Run Registration Form       Saturday, August 17, 2013
WAIVER. I understand that running a road race is a potentially dangerous activity. I do hereby waive and release any and all claims for damages that I may incur as a result of my participation in this event against the Owatonna Hospital, part of Allina Health; Owatonna Rotary; Steele County Free Fair; Owatonna High School; and all employees, volunteers or officials of these organizations. I further certify that I have full knowledge of the risks involved in this event and that I am physically fit and sufficiently trained to participate. If, however, as a result of my participation in the race, I require medical attention, I hereby give consent to authorize medical personnel on site to provide such medical care as deemed necessary.

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

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

PRINT OUT THIS ENTRY FORM AND MAIL IT WITH $25 BY MONDAY, AUGUST 12 TO

Make check payable to Owatonna Rotary

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