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Race with an Angel Registration Form

Age: _____________

Run/Walk:      o Run 5K o   Walk 5K

Gender:           o   Male         o   Female

Birthdate (D/M/Y)  _________/__________/____________

Name: (Last) ________________________ (First) _______________________

Address:     ____________________________________

                   ____________________________________

Phone:    (______) _______- ________________ E-Mail:   ________________________________

School (If student) ________________________

Shirt Size:         oXXL        oXL      oL    oM

Fees:  o $12   Registration before October 1, 2000

          o $10   Students before October 1, 2000

          o $10  FARC

          o $15   All registrations on or after October 1, 2000

Mail this form with registration fee to:

Mary Anne Nee

7280 Jefferson Dr., King George VA 22485

Lu McGowan Waiver:  I know that participating in this event, either as a runner, walker, or volunteer, is a potentially hazardous activity.  I should not enter and participate 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 event.  I assume all risks associated with running in this event, including, but not limited to falls, contact with other participants, the effects of weather, including high heat and 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, for myself, and anyone acting on my behalf, waive and release the Lu McGowan Race Committee and the Fall Festival Committee, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though the liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
 

Signature:  _______________________(Parent's signature if under 18 years old)     Date:   ________