www.RunWalkJog.com
Online Registration Team
Kappa Delta's 5th Annual 5k Roadrace
Shamrock Event for Prevent Child Abuse America
Saturday, March 29, 2008
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Print out and bring the signed waiver to the race. You must have the form completed and turned in prior to event start. |
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Team or Captains, please printout the following Release Form and have each of your participating team members sign their agreement to the following. (Parent must sign if runner is under 18 years old) |
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TEAM RELEASE FORM |
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Liability and publicity release: I know that running a road race is a potentially dangerous activity. I should not enter 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 this event including, but not limited to, falls, contact with other participants, the effects of weather, including heat and humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this wavier and knowing the facts, and in consideration of accepting my entry, I for myself and anyone entitled to act on behalf waive and release Epsilon Pi chapter of Kappa Delta Sorority, the Town of Blacksburg, Virginia Tech, Kappa Delta, Race Officials, volunteers, and all sponsors, their representatives and successors form claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing those of any photographs, motion pictures, recordings, or records of this event for any legitimate purpose. This is a 5k-roadrace/walk and it is not intended for individuals with baby strollers, dogs on leashes, headphones, skateboards, bikes, skates, etc.
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| Team Name: _____________________________________________________ |
| Address: _______________________________________________________________ |
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City: ____________________________
State: ____________ Zip:
______________
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| Team Captain Phone:___________________ Team Captain Email: ___________________ |
| Team Member #1: | _________________________ PRINT NAME |
_________________________ RELEASE SIGNATURE |
| Team Member #2: | _________________________ PRINT NAME |
_________________________ RELEASE SIGNATURE |
| Team Member #3: | _________________________ PRINT NAME |
_________________________ RELEASE SIGNATURE |
| Team Member #4: | _________________________ PRINT NAME |
_________________________ RELEASE SIGNATURE |
| Team Member #5: | _________________________ PRINT NAME |
_________________________ RELEASE SIGNATURE |
Print out and bring the signed waiver to the race. You must have the form completed and turned in prior to event start.