Shalom Run 5K Registration Form
Wednesday, July 4, 2012
WAIVER. With my signature written below, I acknowledge my understanding that participating in the Shalom Run 5K involves a strenuous activity which I am physically capable of undertaking, and I represent that I have received no restrictions on such activity from any physician. I further understand that my participation in the Run/Walk involves inherent risks of personal injury and loss of property. I hereby waive my right to assert any claim that I may have, now or in the future, against Shalom Lutheran Church, the City of Alexandria, and any volunteers or individuals having any connection to the event, for injuries, accidents, property losses or hazardous healthy conditions I might suffer as a result of my participation in this event.
(by parent or guardian if
participant is under 18) ___________________________________________________
PRINT OUT THIS ENTRY FORM AND MAIL IT WITH $20 (Kids Run $10) TO
Make check payable to Shalom Lutheran
Shalom Lutheran Church
800 County Road 44, NW
Alexandria, MN 56308
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