2012
RELEASE, WAIVER, ASSUMPTION OF RISK &
INDEMNIFICATION. I
know that running a road 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 Mt. Misery Team
Relay, July 7, 2012, 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. In consideration for my participation, I, for myself, and
anyone entitled to act on my behalf, waive, release and will indemnify and hold
harmless Seaport Strider Running Club, the City of Asotin, the City of Troy,
Asotin County, Wallowa County, Garfield County, all other sponsors of the race,
their agents, any other persons assisting with the race, and their successors
from all claims of liabilities of any kind arising out of my participation in
the race even though that liability may arise out of negligence or carelessness
on the part of such persons. I understand most roads are gravel, passing
through mountainous areas and there will be no traffic control or emergency
services provided by the race organizers. I will supply my own water, first aid
supplies, and verify all vehicles will be adequately safe for the conditions. I
grant unrestricted permission for the use of any photographs, motion pictures,
recordings or other record of my participation in the race. Parents or
guardians must sign for participants under 18 years of age. My signature
signifies that I have read and understand the terms of this release statement.
Team Name
______________________________________________ Team
Captain_________________________
Estimated Finish Time_________________ E-mail
_______________________________________________
Print each participant's name legibly and place
signature below, make a copy for your information, return this entire page.
Name: Last, First,
Initial Address:
Street, City, St, Zip
Age Sex
T-Shirt Size
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Phone____________________
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3.
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4.
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5.
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Phone ___________________
Team
Relay ($40 x ______ no. of team members) $ ______________ Late Fee of $20 per
team $ ________________
Extra
T-shirts ordered @ $15: No. ________ Sizes________________ Extra Post Race
meals @ $10: No._________
$2 Discount for each Strider Club Member -___________________ Total Amount of Check $_______________