Saturday, March 13, 2010 at 9:00 am

Registration in the Williamsburg City School parking lot

Name:  ____________________________________________________

Street Address:  ___________________________________________

City/State/Zip:  ___________________________________________

Phone:  ____________________________________________________

____ Male    ____ Female

Age on Race Day: ____________                 Birth Date:  ____________

T-Shirt Size: __ Youth Sm. __ Youth Med. __ Youth Lg.

__ Small __ Medium __ Large __ XL __ XXL __ XXXL

Emergency Contact:  _________________ Phone: _____________

Make your tax deductible donation payable to Williamsburg Independent School District*

Mail checks & completed forms to the following:

Attn: Beth Meadors

Williamsburg High School

1000 Main Street

Williamsburg, KY 40769

Pre-registration Deadline: February 19, 2010--$15 Adult Rate--$10 Student Rate

(pre-registration guarantees a t-shirt)

Day of Race Registration from 8:00 – 9:00-- $20 Adult Rate--$15 Student Rate

*The proceeds from this event will be used to benefit the senior class of Williamsburg High School.  All money collected will go towards the senior trip to Washington D.C., New York, and Philadelphia during Spring Break. 

WAIVER

I know that running a road 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 participating in the St. Patrick’s Day Fun Run on March 13, 2010 including, but not limited to, falls, contacts with other participants, the effects of the weather, including high heat and/or humidity, traffic and conditions of the road, all

such risks being known and appreciated by me. I realize that this is a strenuous event which requires proper physical conditioning. I hereby certify that I am in such physical condition and good health.

Having read this release and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act in my behalf or on behalf of my estate, my heirs, executors, administrators and assigns waive and release the Williamsburg Independent School District, any employee or volunteer of the Williamsburg Independent School District and all sponsors of the race, and other persons assisting with the race, the officers, Board, Board members, agents, servants, employees, promoters, managers, directors, officials, agents, and their successors and assigns of each and every of the above from any and all claims of injury or liabilities of any kind including illness or damages suffered by me, arising out of my participation in or traveling to or from this race event even though the liability may arise out of negligence or carelessness on the part of the persons referred to in this waiver.

I also grant permission for the use of any photographs, motion pictures, recordings, or any other record of my participation in this event for any legitimate purpose. I understand that if the race is canceled because of circumstances beyond the control of the race committee and sponsors, including, but not limited to, unsafe weather conditions or governmental ban, my entry fee will not be refunded.

I agree to the above waiver,

________________________________________________________                        _____________________________________

Signature of Participant                                                                     Date

(Signature of Parent or Guardian if under age 18 years)

 

St. Patrick’s Fun Run 5K

                                                                                     Sponsored by WHS Seniors