REGISTRATION FORM
MAYOR'S LABOR DAY RACE FOR HEALTH AND FITNESS
Name: _________________________________________________________________
Age: _________ Sex:
M or F
Phone: _______________________
Address: _______________________________________________________________
City: _________________________________ State: _________
Zip: _____________
Waiver
As a participant in the program, I recognize and acknowledge
that there are certain risks of physical injury and I agree to assume full
risk of ant injuries, damages or loss which I may sustain as a result of
participating in any and all activities connected with or associated with
such program.
I agree to waive and relinquish all claims I may have
as a result of participating in the event against the City and its officers,
agents, servants and employees.
I do hereby fully release and discharge the City, and
its officers, agents, servants and employees from any and all claims from
injuries, damage or losses sustained by me arising out of, connected with,
or in any way associated with the activities of the event.
I further agree to indemnify and hold harmless and defend
the City and its officers, agents, servants and employees from any and
all claims from injuries, damage or losses sustained by me arising out
of, connected with, or in any way associated with the activities of the
event.
I have read and fully understand the above Event Details,
Waiver and Release of all Claims and Permission to Secure Treatment.
Name: (please print): ____________________________________________
Signature: __________________________________________________
(parent
/ guardian if under 18)
Date: ______________________