First Name:
Last Name:
Birth Date:
(mm/dd/yyyy)
Gender: Male Female
Street:
City:
State:
Zip:
Email:
T-Shirt Size:
Wheel Chair:
Stroller:
WAIVER: I know that participating in this walk/run is potentially hazardous. I know that I should not enter unless I am medically able and properly trained. I assume any and all risks associated with this event including but not limited to falls, contact with other participants, the effects of the weather, including to high heat and/or humidity, and the condition of the roads and traffic, all such risks being known and appreciated by me. 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, covenant not to sue, and waive, release and discharge the City of Huntington, Dress for Success River Cities, race organizers, officials, volunteers, sponsors, and/or all their agents, representatives, successors and assigns. This release and waiver extends to all claims or liabilities of every kind or nature, whatsoever, foreseen or unforeseen, known or unknown. Applications for minors are accepted only with a parent / guardian signature.
Participant's Initials:
Date:
(mm/dd/yyyy)
Parent/Guardian Initials (if participant under 18):
Date:
(mm/dd/yyyy)