First Name:

                  Address:

                        City:

                       State:

                           Zip:

                     Gender: Choose One Male Female

               Birth Date:

  Age On Event Day:

                       Phone:

                        Email:

                         Event:              Select One 5K Run 5K Walk 10K Run 10K Walk Fun Run

                   Shirt Size: Choose One Small Medium Large X Large Fun Run No Shirt

LIABILITY WAIVER:

If the waiver is not signed the registration form will be returned I know that running a race is a potentially hazardous activity and that 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 this event including, but not limited to: falls, contact with other participants and wildlife, the effects of the weather, including cold and/or rain or snow, traffic and the conditions of the road and path, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the organizers of the Rolling Hills Classic, City of Rexburg, Idaho, Butt in Gear, and all other sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event or carelessness on the part of the persons named in this waiver. Further, I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for legitimate purposes.

  
                                          Waiver: Choose One Yes

                                      Signature:

Parent Or Guardian If Under 18:

Enter Amount Below, If you would like to make a donation pledge to the Rolling Hills Classic.  Leave blank if you do not wish to make a donation.

  Donation Pledge: For the Rolling Hills Classic.  Please bring pledges to event.

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