Due West Fire “K” Run
Saturday September 25, 2010
Registration 8:00 a.m.
Run/Walk Race Time 8:30 AM
Fun Run 9:45 a.m.
Run/Walk Will Begin at Due West ARP Church
Parking Lot
Fun Run Will Begin At Corner of Beulah St
and Strong Circle
Please
complete entire form/ one person per entry form.
Name__________________________________________________
Address________________________________________________
Phone________________________ e-mail___________________________________
Awards: Trophies for overall
male in the run & overall female in the run, overall male in the walk,
and for the overall female in
the walk.
Medals for top 2 in each age
group in the run & Medals for top 2 in each age group in the walk.
____5Krun/walk ____Fun Run $15 advance - $20.00 after 08/31/10 Age of
participant ________
T-shirt guaranteed to
Pre-Registered Racer –
late registration T-shirts will be on a first come first serve basis.
T-shirt Size ____Adult small _____ Adult medium ___ Adult large
____ Adult X-large _____ Adult 2X
____ Child small ____ Child medium ____Child large
Waiver: 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 also know that there will be a possibility of
traffic on the course. 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 the weather
and the conditions of the road, all such risk being known and appreciated by
me. Furthermore, I agree to yield to all emergency vehicles. I also am fully
aware that baby strollers and wheels of any kind (except competitive wheel
chairs), animals and head phones are strictly prohibited and I agree not to
have them on the course. Furthermore I agree not to go back on to the race
course after finishing. I am fully aware that it is a fraudulent act to switch
race numbers with anyone or allow anyone other than myself to wear my race
number and I agree not to do this. Knowing these facts, and in consideration of
you accepting my entry, I hereby for myself, my heirs, executors,
administrators or anyone else who might claim on my behalf, covenant it not to
sue, and waive and release and discharge any and all race sponsors, race
officials, race volunteers, local and state police including any and all their
agents, employees, assigns or anyone acting for them on their behalf from any
and all claims or liability for death, personal injury or property damage of
any kind or nature whatsoever arising out of, or in the course of, my
participation in this event whether same be caused by negligence or fault. This
release and waiver extends to all claims of any kind or nature whatsoever,
foreseen or unforeseen, known or unknown. The undersigned grants permission to
sponsors or agents authorized by them to use any photos, videotapes, motion
pictures, or any other record of the event for any purpose. Minors accepted
only with a parent or guardian signature.
Signed__________________________________________________
Date______________________________
Make Checks Payable to: Due West Fire &
Rescue