Patriots for Patriots

2 Mile Fun Run/Walk
Saturday, November 12, 2016
9:00 am Start

Race Location: Buffalo Springs Lake

Details: This race is being held in conjunction with a West Texas Running Club race. West Texas running club will be responsible for finishing information and awarding medals to placers.

Proceeds: All proceeds from our group will benefit local veterans through Vet Star

Information: $30.00 to participate T-shirt included. Any donations are welcome if you are unable to participate. Please make checks payable to ASES. Contact abray@allsaintsschool.org with questions.

Deadline: Forms and money due by Monday, October 31st  (to receive a race shirt), forms will be accepted until Wednesday, November 9th (Cost 20.00 / no race shirt).

PATRIOTS FOR PATRIOTS ENTRY FORM FOR PARTICIPANTS   PLEASE PRINT LEGIBLY

First Name__________________ Last Name___________________________ Sex____

Age on race day MM___ DD___YYYY email__________________________Phone#_______________________________
Address ____________________________________________________________
City, State Zip ________________________________________________________
WTRC member y/n

Emergency Contact_________________________Phone__________________________
SHIRT SIZE (circle One)       SM         M        L       XL       NONE

 

Waiver (MUST BE SIGNED)

I know that running and volunteering to work in club races are potentially hazardous activities. I should not enter and run in club activities 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 and volunteering to work in club races including, but not limited to, falls, contact with other participants, the effects of   the   weather, including high heat and/or humidity, my own health conditions, whether known or unknown to me, the conditions of the road and traffic on the course, all such risks being known and appreciated by me.

Having read this waiver and knowing these facts, I, for myself and anyone entitled to act on my behalf, waive and release the West Texas Running club and all sponsors, their representatives and successors, from all claims or liabilities of any kind arising out of my participation in the race or other club activities, even though that liability may arise out of negligence or carelessness, in part or whole, of the West Texas Running Club or other sponsors referenced above.

This entry is not valid unless signed by the entrant, guardian, conservator, or parent for entrants under 18 years old.

Note: Our Insurance policy prohibits strollers, roller blades, pets and bicycles at WTRC events.

 

Signature of Participant/Guardian if under 18

 

_________________________________________Date_____

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