REGISTRATION FORM
Ocean City Police Chase 5K
JUNE 17, 2006
Name ____________________________________________________________
Address __________________________________________________________
City ________________________________ State ______ Zip
_______________
Age on 6/17/06 __________ Sex _________
Telephone _________________ Email __________________________________
Name of Team _____________________________________________________
Name of Public Service Department _____________________________________
(Must be filled out by each individual runner to be counted
in the individual open and/or team results)
Shirt Size: M ___ L____ XL ____
WAIVER: Read and Sign
In submitting my entry, I for my myself, my heirs, executors and administrators,
waive and release any and all rights and claims for damages I may have now or
hereafter arising against the Ocean City Police Chase, all sponsors, the Ocean
City Police Benevolent Association, Ocean City Police, City of Ocean City, Philadelphia
Athletic Charities, Inc., officers, employees, principles, and all race volunteers,
including but not limited to any and all claims of damages, injuries, demands,
actions, whatsover, however they may occur, arising as a result of my participation
in the Ocean City Police Chase. I acknowledge that I am aware of the inherent
risks in participating in an athletic event of this type. I attest that I am
physically it and trained for the completion of this race and my fitness and
health has been verified by a licensed medical doctor. Furthermore, I hereby
grant full permission to any use of my likeness for print, telecast, advertising,
or promotion of this event whatsoever. I understand that this Entry is nonrefundable
and numbers are nontransferable.
____________________________________________________________ Date _______________________
Signature of Adult or Parent if racer is under 18
Waiver must be signed by each individual runner to compete in the race.