walk for water registration form 1

							 Boonville Walk for Water Registration Form
                                   Runner Information
                Name:      ______________________________________________________
                           Last,                   First


                Address: ______________________________________________________

                         ______________________________________________________

                Phone: (       ) _________--____________

                Email: ________________________________________________________

                Age: ________

                Gender: M            F

                Shirt size:    S    M       L       XL
Reminder:
Please send your $15 registration fee, payable to Boonville High School.
                                                       th
Registration forms not received on or before April 25 will be charged a $5 late
fee and will not be guaranteed a free shirt. The race will start at the Boonville
Chamber of Commerce, 320 1st Street Boonville MO. Registration/Sign-in will
begin at 8:00 am. The race will start at 9:00 am.
Waiver
I know that this event is a potentially hazardous activity and I hereby assume full and complete
responsibility for any injury or accident which may occur during my participation in this event or while
on the premises of this event, and I hereby release and hold harmless and covenant not to file suit
against Boonville High School, any sponsors and their agents and employees and all other persons or
entities associated with this event from any loss, liability or claims I may have arising out of my
participation in this event, including personal injury or damage suffered by me or others, whether same
be caused by falls, contact with participants, conditions of the walk route, negligence, or otherwise. If I
do not follow all the rules of this event, I understand that I may be removed from the walk.


Signature: ______________________________________________ Date: __________________
           (Parent/Guardian signature is required if participant is not 18 years of age)