2009
RELEASE, WAIVER, ASSUMPTION
OF RISK & INDEMNIFICATION. 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 risks
associated with running in the Mt. Misery Team Relay, July 11, 2009, including,
but not limited to, falls, contact with other participants, the effects of the
weather, including high heat and/or humidity, traffic and the conditions of the
road, all such risks being known and appreciated by me. In consideration for my
participation, I, for myself, and anyone entitled to act on my behalf, waive,
release and will indemnify and hold harmless Seaport Strider Running Club, the
City of Asotin, the City of Troy, Asotin County, Wallowa County, Garfield County,
all other sponsors of the race, their agents, any other persons assisting with
the race, and their successors from all claims of liabilities of any kind
arising out of my participation in the race even though that liability may
arise out of negligence or carelessness on the part of such persons. I
understand most roads are gravel, passing through mountainous areas and there
will be no traffic control or emergency services provided by the race
organizers. I will supply my own water, first aid supplies, and verify all
vehicles will be adequately safe for the conditions. I grant unrestricted
permission for the use of any photographs, motion pictures, recordings or other
record of my participation in the race. Parents or guardians must sign for
participants under 18 years of age. My signature signifies that I have read and
understand the terms of this release statement.
Team Name
______________________________________________ Team
Captain_________________________
Estimated Finish Time_________________ E-mail
_______________________________________________
Print each participant's name legibly and place
signature below, make a copy for your information, return this entire page.
Name: Last, First,
Initial Address: Street,
City, St, Zip
Age
Sex
T-Shirt Size
1. _______________________________ __________________________________
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x
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__________________________________ Phone____________________
2.
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x ________________________________ __________________________________ Phone
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3.
_______________________________ __________________________________
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x ________________________________ __________________________________ Phone
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4.
_______________________________ __________________________________
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x ________________________________ __________________________________ Phone
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5.
_______________________________ __________________________________
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x ________________________________ __________________________________ Phone
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6.
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x ________________________________ __________________________________ Phone
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Team
Relay ($40 x ______ no. of team members) $ ______________ Late Fee of $0 per
team $ ________________
Extra
T-shirts ordered @ $15: No. ________ Sizes________________ Extra Post Race
meals @ $15: No._________
$2 Discount for each Strider Club Member -___________________ Total Amount of Check $_______________