Run For Hope 10k/5k Race Registration Form printable pdf download

Run for Hope 10k/5K Race

Registration Form

May 16th 8:00 a.m.

Pipestem State Park

First Name ________________________________ Last Name__________________________________________________

Email____________________________________________________________________________________________________

Address _________________________________________ City________________ State_______ Zip Code___________

Phone (____) ________________ Date of Birth__________________ Age on Race Day___________ Gender M F

Age Division:

0-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Shirt Size: Youth S

Adult

XXL

XXXL

(T-shirts will NOT be guaranteed for those who register after May 1st)

Event:

5k run

5k walk

10K

Registration Fees prior to April 30: $25

After April 30: $30 (

checks payable to Jonathan Powell

)

Hope Foundation. Please send registration to CFC, 119 Brick St, Princeton, WV 24740

Registration:

, May 16, 2015 at the

From 6:30- 7:45 am

at the Pipestem tram

Call Erica Morgan for information or questions at 540-250-0678

Race at Pipestem State Park on May 16th at 8:00 am. Registration is at the tram from 6:30- 7:45 am, start for

both races at the amphitheater parking lot.

Participant Consent

I understand that all proceeds of the race goes to the Jonathan Powell Hope Foundation. I know that

running a race is a potentially hazardous activity. I should not enter and run 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 in the event, including, but not limited to, falls, contact with other participants, the

effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks

being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your

accepting my entry, I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my

behalf, waive and release any and all sponsors, their representatives and successors, from all claims or liability for

death, personal injury, or property damage of any kind or nature whatsoever arising out of, or in the course of, my

participating in this event whether same be caused by negligence or fault. This release and waiver extends to all

claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. The undersigned further

grants full permission to sponsors and or agents authorized by them to use any photographs, videotapes, motion

pictures, recordings, or any other record of this event for any purpose. Minors accepted only with a parent or

guardian's signature.

Signed________________________________________________ (waiver must be signed to participate)

Date:________________________

Run For Hope 10k/5k Race Registration Form

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