John Barker 5K Run and 1 Mile Walk
Registration Form
Name _______________________________________________________________
Sex _________ Age ________ Phone
_______________________________
Address _____________________________________________________________
City _____________________________ State ________ Zip
Code __________________
Runner _____ Walker ______
Pre-registration - $15.00 per person
Day of Event - $20.00 person
Family of 4 - $45.00
Running Club (minimum of 8) $12.00 per person
Name of Running Club ________________________________________________
I know that running a 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 weather, including heat and/or humidty;
traffic and other 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 entitled
to act on my behalf, waive and release the John Barker 5K Run Fund, the
Borough of Barrington, the town of Haddon Heights 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
names in this waiver.
I grant permission to all of the foregoing to use photographs,
motion pictures, recordings or any other record of this event for any legitimate
reason. I understand that bicycles, skateboards, baby joggers, roller skates
or blades, animals and radio headsets are not allowed in the race and I
will abide by this guideline.
Signature _______________________________________________ Date ______________
Parent's signature if under 18 years of age _____________________________________
Date ________
Make checks payable to: John Barker 5K Run Fund
Send with signed registration form to:
The John Barker 5K Run Fund
PO Box 16
Barrington, NJ 08007