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| Mail form to the above address or deliver to The Sports Center: 701 N. 35th St. or The Athlete's Foot: 278 Highway 24 - Suite C | ||||
| First Name _________________________________
M.I. _______ Last Name _________________________________
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| Participating Family Members ________________________________________________________________________ | ||||
| Mailing Address ______________________________________________________________________________ | ||||
| ______________________________________________________________________________ | ||||
| Phone Number (Include Area Code) ____________________________________________________ | ||||
| Email Address ___________________________________________________________ | ||||
| Age on Race Day_____ Gender Male_____ Female_____ Men's T-Shirt Size S_____ M_____ L_____ XL_____ | ||||
| Select Race | ______ 5K Fitness Walk | ______ 1 Mile Fun Run | ||
| ______ 10K Run | ______ 5K Wheelchair | ______ 1 Mile Fitness Walk | ||
| ______ 5K Run | ______ 10K Wheelchair | ______ 1 Mile Tot Push or Pull | ||
| ENTRY FEE $ ______________ | ||||
| INDIVIDUAL: $30.00 | FAMILY: 60.00 | ||||
| DISCLAIMER | ||||
I know that running a road race is a potentially hazardous activity. I should not enter and run/walk 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 race. I assume all risks associated with running/walking in this event including, but not limited to, falls, contact with other participants, the effects of the weather, including heat or humidity, traffic, and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Sports Center, the Morehead City Lookout Rotary Club, and all sponsors, their representatives, and successors from all claims of liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. In consideration of your accepting this entry, I, the undersigned, intending to be legally bound hereby, for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have, or that might acdrue against the Morehead City Lookout Rotary Club and its agencies, officers, and employees, for any and all injuries suffered by me in said event. |
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| SIGNATURE _________________________________________________________________ |
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| PARENT'S SIGNATURE
IF UNDER 18 _________________________________________________________________ |
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| DATE _______________________________________ |
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