5K/10K Run/Walk

5K/10K Run/Walk

Christian County Run for a Cure 5K/10K/Walk
Registration Information:

Gender: *

T-Shirt Size: *

Based on adult sizes (NO YOUTH SIZES) Add $1 for XXL

I will be participating in the: *

(Check one)

Registration Fee:

$25 (register by September 15, 2012 guarantees t-shirt)

Checks payable to EBC Relay for Life

How to Register:

Complete this form, electronically sign the waiver below, and mail your entry fee to:

Debbie Sowell

Christian Co. Run for a Cure

3303 Southgate St. 

Hopkinsville, KY 42240

(Contact info: Debbie Sowell 270-889-7771 or dsowell@ymail.com)

All Proceeds Benefit American Cancer Society's Relay for Life - Christians County, Kentucky

Help Us Make this year the "Best Birthday Ever"!!

Waiver of Liability and Release:

I, the undersigned participant in the "Christian County Run For A Cure 5K/10K Run/Walk" do hereby agree for myself, my heirs, executors and assigns that Derborah Sowell, Edgewood Baptist Church, City of Hopkinsville, Christian County Fiscal Court and any agents, officers, employees and sponsors thereof, shall be released from any and all claims for personal injury or injury, loss, or damage to personal property suffered of sustained by me in connection with, or arrising out of or resulting from any and all activities associated with the "Christian County Run For A Cure 5K/10K Run/Walk".

I further assume the risk of personal injury, loss or damage to myself and loss, injury and damage to my property while on the premises while participating in the "Christian County Run For A Cure 5K/10K Run/Walk".

I state that I am physically able to complete my registered event.

I understand that the race course closes at 9:00am and if I have not completed the event at that time, I am subject to being removed from the course. 

I grant the on-site medical personnel my permission to treat me, if needed during an emergency and if I am unable to consent to any necessary treatment for my personal health and welfare during my participation in this event. 

(Typing your name in the space recognizes the above information to be true and understood)

(Type the name of the Parent/Guardian of the above signed name)