Maple Lake Irish Scamper Registration Form       Saturday, March 17th

WAIVER. In consideration of the acceptance of my entry, I, intending to be legally bound, do hereby for myself and my heirs, executors, and administrators waive and release any and all rights and claims for damages and cases of suit or action, know or unknown, that I have against the Maple Lake Irish Scamper, SIRF, the city of Maple Lake, and Wright County, through which the race is routed and all participating race sponsors, directors, officers, employees, volunteers and agents for any and all injuries resulting from my participation in the Irish I attest that I am physically fit and have sufficiently trained for this event, my physical condition verified by a licensed M.D. during the last six months. I also grant permission for a doctor and/or nurse to take remedial action in case of an emergency. I attest and verify that I have full knowledge of the risks involved in a race, and that I assume all expenses in the event of an accident, illness or other incapacity, regardless of whether I have authorized such expenses.

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

PRINT OUT THIS ENTRY FORM AND MAIL IT WITH $20 BY MARCH 12 TO

Make check payable to MLHS

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