Firecracker 5,000 – July 4th, 2010

(If you want your name listed on the results, please print so we can read it!!)

 

Name:__________________________________________________________________

Phone:  _________________________________________________________________

Birth date:  ______________      Age on race day:  ___________

Gender (circle one):     M         F

$10.00 Adults ______                $5.00 Kids under 16 _____

I know that running a road race is a potentially hazardous activity. I should not enter and run 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 in this event, including but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks of being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my entry, I, for myself and anyone entitled to act on my behalf, waive and release the town of Friday Harbor, the County of San Juan, Island Athletic Events, LLC, all sponsors and contributors, volunteers and 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 grant my permission to all of the foregoing to use photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. I also understand that my entry fee is non-refundable. A parent must sign if entrant is under 18 years of age. This is to certify that my child has permission to compete in this event, is in good physical condition, and the event officials may authorize necessary emergency medical treatment. I understand that bicycles, and skateboards are not allowed in this race, and I will abide by this guideline.

Participant Signature/Date:_________________________________

 Parents Signature (if under 18):  _________________________