REGISTRATION FORM
$15 race day
Please bring this completed form with you to the race
July 4th
NAME: ______________________________________________________________
ADDRESS: ___________________________________________________________
CITY: _______________________________________ STATE: _______
ZIP _____________
PHONE: __________________________________
MALE ____ FEMALE _____ AGE
_________
EMAIL ___________________________________
In consideration for accepting this entry, and the granting of the privilege
to participate in this event, I the undersigned, intending to be legally bound,
hereby, for myself, my heirs, personal representatives, successors, and assigns,
waive and release any and all claims for losses and damages I may have against
Marlton Recreation Association, including it's officers and employees, Firecracker
5k race committee volunteers and sponsors, Woodstown Borough, Pilesgrove Township,
L & M Computer Sports, their representatives, successors and assigns/or
other person whomsoever for any and all injuries, illness, including death,
that may results from any participation in said event. I represent and affirm
that I am in proper physical condition to participate in this event, and verified
by a licensed physician, and have sufficiently trained for the competition of
this event.
The undersigned has read and voluntarily signed this release and waiver:
Signature ________________________________________________ Date
________________
(Parent sign if under 18 years of age)