Make checks payable to:
Makin’ Tracks Race
Mail to:
PHS/Roger White
1055 Edmond Road NW
Piedmont, OK 73078
ENTRY FORM: (Please print):
Name ___________________________________________ Age on Sept 1st ______
Date of Birth __________________ Male ____ Female ____
Address ____________________________________________ __
City _____________________________ State ________ ZIP _____
Day Phone: (_____) _________________ Night Phone: (_____) ________________
E-Mail Address: __________________________________
Event 5 KM Race _______ Half mile Fun Run/Walk ________ 5 km Wheelchair ________
Clydesdale (170+ lbs) ________ WT _______ Filly (145 + lbs) _______
T-Shirt: Youth sizes Medium ____ Adult sizes: Small ____ Medium _____ large _____ XL ______ XXL ______
Entry fee enclosed _____________
Waiver (Must be signed to enter):
NO REFUNDS USAT&F Certificate 94040BB
I know that running a road race is a potentially hazardous activity. I also know that there will be a possibility of traffic on the course. I assume any all risks associated with running this race. I understand the risk of running in traffic. I assume any and all risks associated with running this event including, but not limited to falls, contact with other participants, the effects of the weather and the conditions of the roads, all such risks being known and appreciated by me. Furthermore, I agree to yield to all emergency vehicles. I understand the Makin’ Tracks Race may be cancelled in the sole judgment and discretion of the sponsors. I agree that the starting time of the race maybe changed at the sole discretion of the sponsors. I am fully aware that baby strollers and wheels of any kind (except in the competitive wheelchair event), animals, and headphones are strictly prohibited, and I agree not to have them on the course during sanctioned events. Furthermore, I agree not to go back onto the course after finishing. In consideration of my entry acceptance in the Makin’Track race events, I do hereby for myself, my executors, administrators and assessors, release and discharge any and all race sponsors, race officials, volunteers, local and state police including any and all of their agents, employees, assigns or anyone acting for or on their behalf from any and all claims or liability for death, personal or property injury, damages or demands or actions whatsoever in any manner arising out of my participation in said athletic event. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. I attest and verify that I have full knowledge of the risks involved in this event and am physically fit and sufficiently trained to participate in this event. The undersigned further grants full permission to sponsors and/or agents authorized by them to use any photographs, videotapes, motion pictures, recordings or any other record of this event for any purpose. Applications for minors accepted only with a parent or guardian’s signature.
THIS WAIVER IS A LEGAL DOCUMENT. READ ALL TERMS AND CONDITIONS BEFORE SIGNING.
ABOSOLUTELY NO WHEELS, INCLUDING BABY CARRIAGES, OR ANIMALS OF ANY KNIND ON THE COURSE. NO REFUNDS.
Signature _______________________________________________________________________ Date __________________
___________________________________________________________________
__________________________
OFFICAL USE ONLY: ___________________________ RUNNERS # _______________ |
