First Name:

     Address:

            City:

          State:

             Zip:

        Phone:

         Email:

            Age:

           Sex:   Select One Male Female

         Event: Select One 10K 5K Kids Run

WAIVER OF LIABILITY: I know participating in any event is a potentially hazardous event. I am in adequate physical condition to participate. 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 participating in this event including, but not limited to: illness, falls, contact with other participants, the effects of the weather, traffic and conditions of the road. Having read this waiver and knowing these facts and in consideration of acceptance of my entry, I waive and release the Rockingham County Fairgrounds, Shenandoah Valley Track Club, and Harrisonburg Baptist Church, all sponsors and its directors, officers and staff and volunteers from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons covered by waiver and release. I understand and agree that the entry fee is a non-refundable and non-transferable. I grant permission to all of the foregoing to use any photography, recording, either sound or video, or any other record of this event for any legitimate purpose without charge.

      Waiver: Select One Yes I accept the Waiver

  Signature:                    (Parents Signature required if under 18)

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