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Info
Entry
Results
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*OFFICIAL ENTRY FORM*
_____ 5K Walk _______ 5K Run ______ 10K Run
LAST NAME _______________________________________
FIRST NAME _______________________________________
STREET ADDRESS __________________________________
CITY _______________ STATE _______ ZIP______________
PHONE ____________________________________________
DATE OF BIRTH ___________________ AGE ____________
SHIRT SIZE (CIRCLE): S M L XL
_________ MALE __________ FEMALE
WAIVER MUST BE SIGNED:
In signing this form, I understand that participating in this event is a
potentially hazardous activity. I should not participate unless I am medically
able. I assume all risks associated with my voluntary participation in this
event, including, but not limited to falls, contact with other participants, the
effects of weather, including extreme temperatures and precipitation and
traffic. Knowing these factors, I for myself, heirs, executors, administrators
or anyone else who might claim on my behalf, covenant not to sue and WAIVE,
RELEASE AND DISCHARGE the City of Plymouth, the Plymouth Parks Department,
Memorial Hospital and its affiliates, their agents, employees, officers,
directors, successors and assigns, and ALL other sponsors, race officials,
workers, or volunteers, their representatives, successors and assigns, and any
other person or entity associated with this event in any capacity whatsoever,
for ANY AND ALL claims or liability, whether foreseen or unforeseen, for death,
personal injury, or property damage arising out of, or in the course of, my
participation in this event. I further understand that I will not be allowed to
participate in this event unless and until this release and waiver has been
executed by me. My signature below constitutes conclusive proof that I have
read, and understand the above terms and agree to be bound by said terms. I
grant permission for organizers to use photographs of me and quotations from me
in promotion of this event.
Signature:_____________________________________
Date:____________________
If under 18, Signature of parent: Date:________________
For more information or questions please call:
574.936.2284
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