Available for print @ www.midmainelacrosse.com soon.

Teachers on the Run 5K

REGISTRATION FORM

Please mail to: Kelly McCullough - HCS

62 Elm St., Hartland, ME 04943

NAME:_________________________________________AGE:_____________

ADDRESS:______________________________________________________

PHONE #:__________________________   E-MAIL:______________________


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Participant Waiver for Race Registration

I know that running a road race is potentially hazardous activity, which could cause injury or death. I will not enter and participate unless I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this event, and am in good health, and I am properly trained. I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I assume all risks associated with running in this event, including but no 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 ad knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Teachers on the Run 5K Race Series, the town of Hartland, 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 that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.   I also grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record of this event for any legitimate purpose.

Signature:_______________________________________________________________Date:_______

Parent’s Signature if under 18 years:

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