Registration Form

Road Warrior 5K

Support White County Middle School Football & Cheerleaders

8:00AM, September 27, 2014 @ White County High School

Race day registration begins at 7:00AM

Early registration - $25  Race day registration - $30

Name: _____________________________________________________

Address: ___________________________________________________

City: ________________________ State: _________ ZIP: ___________

Phone: _________________Email: ______________________________

Age (on race day): _________________________________

Circle shirt size:   XS   S   M   L   XL  (Register by 09/11/14 to guarantee shirt size)


ATHLETE'S RELEASE: PLEASE READ, TO RUN THE RACE, YOU MUST SIGN AND DATE
I know that running and volunteering to work in club races are potentially hazardous activities.  I should not enter and run the Road Warrior 5K 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 and/or volunteering to work in the aforementioned race, including but not limited to falls, contact with other participants, the effects of weather including high heat or humidity, ice and snow, the condition of the road and traffic on the course, all such risks being known and appreciated by me.
Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I for myself, and anyone entitled to act on my behalf, waive and release White County Schools any and all members thereof, and all further sponsors, their representatives, successors, from all claims or liability of any kind arising out of my participation in the aforementioned event, even though that liability may arise out of negligence or careless on the part of the persons named in thie waiver.  I also grant permission to all the foregoing to use any photograph, motion pictures, recording, or any other record of this event for any legitimate purpose.


SIGNATURE: ________________________________________________________________

Parent Signature (if runner under 18): ______________________________________________

Date: _______________________________