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2013 Heart & Sole 5K On-Line Registration

2013 Heart & Sole 5K On-Line Registration

Required fields are marked with a

NAME:

 

ADDRESS:

 

CITY:

 

STATE:

 

ZIP:

 

PHONE:

 

EMAIL ADDRESS:

AGE:

 

GENDER:

 

TYPE OF PARTICIPANT

 

ADULT SHIRT SIZE

$25 Registration Fee is due by Monday September 9th, 2013! WAIVER: In consideration of my signed acceptance of this entry, I waiver and release my rights and all claims against the sponsors and producers of this event for any injuries or illness which may directly result from participation in this race or on the premises of this event. I further attest that I am in proper physical condition and assume all risks associated with running in this event including, but not limited to falls, contact with other participants, effects of weather, traffic and the conditions of the road. All such risks are hereby waived and I release JCH Wellness Center of Jerseyville and all persons associated with this event from all claims or liabilities of any kind arising from my participation in this event.

Participant’s Signature OR Parent/Guardian Signature:

 

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