Running for Life 10K / 1 Mile Fun Run/Walk by jD0fQI

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									Running for Life                                 10K / 1 Mile Fun Run/Walk                                          2012 REGISTRATION FORM
June 16, 2012 / Standing Rock, Steamboat, AZ (Located on the Navajo Reservation in Northern Arizona)
                                           Bib number must be worn by the assigned participant.
    Sorry no bicycles, scooters, 4 wheelers, motor bicycles or pets allowed by participants or spectators. Sorry, no refunds or transfers.   [   ]   10 K
                 EVENT NOTE: A separate entry form is required for each participant.                                                         Run
                                      PLEASE PRINT
 Name:                                                             [   ] Female
                                                                                                                                             [   ] 1 Mile
 Date of Birth:                                                                                   [      ] Male                              Fun Run/Walk
 Address:                                                                                                                                    Age on Race
 City:                                                        State:                                      Zip:                               Day:
 Phone #:
 Email Address:                                                                                                                              T-Shirt Size
 In case of Emergency:                                                                                                                       [   ] Small
 Contact Name:                                                                                                                               [ ] Medium
 Phone #:
                                                                                                                                             [ ] Large
                                              Race numbers are non-transferable.
                                                                                                                                             [ ] XL
                   Waiver (please Read and Sign Below – Waiver must be signed)
                                                                                                                                             [ ] 2XL
 I UNDERSTAND THAT PARTICIPATION IN THE EVENT “RUNNING FOR LIFE 10K RUN OR 1 MILE FUN RUN/WALK”
 AS A REGISTERED PARTY SHOULD NOT PARTICIPATE UNLESS MEDICALLY ABLE AND PROPERLY TRAINED. I
 UNDERSTAND THAT THIS EVENT MAY BE HELD OVER TRAILS AND OVER PUBLIC ROADS AND FACILITIES OPEN
 TO THE PUBLIC DURING THE EVENT AND UPON WHICH HAZARDS ARE TO BE EXPECTED. PARTICIPATION
 CARRIES WITH IT CERTAIN INHERENT RISKS THAT CANNOT BE ELIMINATED COMPLETELY RANGING FROM
 MINOR INJURIES TO CATASTROPHIC INJURIES. I UNDERSTAND AND AGREE THAT IN CONSIDERATION OF BEING
 PERMITTED TO PARTICIPATE IN THE EVENT I AND ANY REGISTERED PARTY, MY HEIRS, PERSONAL
 REPRESENTATIVES OR ASSIGNS OF MINE OR THE REGISTERED PARTY DO HEREBY RELEASE, WAIVE, AND
 DISCHARGE NOT TO SUE OR PLACE CLAIM OF ANY KIND AGAINST RUNNING FOR LIFE, JOHN CURLEY JR,
 ELAINA VANN, STANDING ROCK PARTIES, COMMUNITY/FAMILIES OR ANY OTHER PARTIES/SPONSORS
 AFFILIATED WITH THE EVENT FOR ANY AND ALL LIABILITY FROM ANY AND ALL CLAIMS ARISING FROM
 PARTICIPATION IN THE EVENT BY MYSELF OR ANY REGISTERED PARTY.

 BY INDICATING MY ACCEPTANCE OF THIS AGREEMENT AND WAIVER, I AM AFFIRMING THAT I HAVE READ
 AND UNDERSTAND THIS AGREEMENT AND WAIVER AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND
 THAT I AM GIVING UP SUBSTANTIAL RIGHTS, INCLUDING THE RIGHT TO SUE. I ACKNOWLEDGE THAT I AM
 SIGNING THE AGREEMENT AND WAIVER FREELY AND VOLUNTARILY, AND INTEND BY MY ACCEPTANCE TO
 GIVE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY
 LAW.
 Signature of Entrant:                                                                                                               Date
 X
 Signature of Parent or Guardian (if entrant is under the age of 18)                                                                 Date
 X

 For Official Use Only:                                                                                                       Race #

 Date Rec.                                                                           Date Rec.
 10 K Run                                                                            1 Mile Fun Run/Walk

 [ ] $20.00 (Early Registration)                                                     [ ] $10.00 (Early Registration)

 [ ] $25.00 (Day of Race)                                                            [ ] $13.00 (Day of the Race)

								
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