![]() | Fulmont Roadrunners Club's 18th Annual Winter Wimp Saturday, January 10, 2004, at 1:00 p.m. Snow or Shine! |
Name_______________________________________________________________
Age__________________________
Date of birth______________________________________
Sex_______________________________
Address__________________________________________________________________________________________
Phone_____________________________________________
FMRRC member?__________________________
I know that running races 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 running in the race including, but not limited to, falls, contact with other participants, the effects of the weather, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release the Road Runners Club of America, the Fulmont Roadrunners Club, the Village of Hagaman, N.Y., and all sponsors, their representatives, and successors from all claims or liabilities of any kind arising out of my participation in the race even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
Signature____________________________________________________________
Parent or quardian signature (if under 18)_____________________________________________________
Date_________________________________
Mail completed application with check payable to Fulmont Roadrunners Club to Rick Vertucci, P.O. Box 188, Fort Hunter, NY 12069.