First Name:

        Address:

               City:

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            Email:

           Phone:

Age On Race Day:

                     Event:   Select Event 5K Run 5K Walk Child Fun Run

THE UNDERSIGNED, being a participant in the Hot Chocolate Classic 5K Run/Walk and 1 Mile Fun Run, and in consideration of the acceptance of my entry and registration to participate therein, does hereby forever release and agree to hold harmless The Foundation for Rankin County Public Schools, Inc., the Rankin County, Mississippi School District, The Mississippi Track Club, Inc. and any and all sponsors and providers of the Hot Chocolate Classic or any of their officers, boards, employers or agents, both individually and in their official capacities as such, from any and all claims, rights, demands or causes of action of every kind and character arising from any injuries or damages sustained by me in the Hot Chocolate Classic, it being understood and agreed that such release from liability and hold harmless agreement shall include but not be limited to any cause or causes of action related to personal injury, death, and/or hospital or medical bills or expenses of any other kind or nature which I may suffer or incur as a result of my participation in the Hot Chocolate Classic.

I further warrant and represent that I am in proper physical condition to participate in the Hot Chocolate Classic and am not participating in this event without consultation with my physician or against physician’s advice nor am I taking medications which would impair my health or ability to participate in the Hot Chocolate Classic.

Agree With Waiver: Select Yes

                Signature:     (Parents Signature required if under 18)

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