ENTRY FORM AND RELEASE
Area 7 Special Olympics New Jersey
A Very Special 5K/1 mile Fun Run
Wednesday, June 11, 2003
All participants Must Complete and sign this form.
Make checks payable to: Area 7, Special Olympics
Send check & Entry Forms to:
- Russ Laraway
- 843 Richmond Drive,
- Sicklerville, NJ 08081
Name _____________________________________________
Street Address __________________________________________
City _______________________________ State ____ Zip Code
_________
Phone ______________________________
Email ______________________________
Age ______ Sex ____ Shirt Size M __ L __ XL
___
5K Run _____ 1 Mile Fun Walk ____ Wheelchair _____
Race fee: $ ___________
Relase and Wavier ( All Entrants must sign )
Waiver Release Form: In consideration of my entry into the 2003
"A Very Special 5K" being accepted, I , intending to be legally bound,
hereby, for myself, my heirs, executors, and administrators, waive and release
Special Olympics, New Jersey, and Area 7 (Special Olympics), Washington Township
Park Service of New Jersey, heirs, and assigns as well as all Special Olympic
volunteers, participants, and sponsors from all liability claims, demands, losses,
or damages suffered by me in said event. I represent that I understand the nature
of the event and that I am qualified in good health and in proper physical condition
to participate in such an event. I hereby grant my full permission to any and
all of the foregoing to use my photographs, videotapes, motion pictures, recordings
or any other record of this event for any legitimate purpose.
_______________________________________________________________
Signature(parent or guardian if under 18)____________Date