Club South Runners STANDARD ENTRY FORM

Make Checks payable to Club South Runners

Mail to P. O. Box 65123, Baton Rouge, LA 70896

Event Name

CIRCLE ONE: T SHIRT SIZE: S M L XL XXL NO SHIRT

NAME:____________________________________________________________________

MAILING ADDRESS_________________________________________________________

CITY/STATE/ZIP__________________________________________________________

CIRCLE: MALE FEMALE Age:___________________ Birth date:___________________

Phone Number: Area Code & Number_________________________________________

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Participation Legal Waiver Please send waiver along with Check for Race Entry I know that running and/or volunteering to work in Club South Runners events are potentially hazardous activities. I should not enter and or run in Club South Runners activities unless I am medically able and properly prepared and/or trained. I agree to abide by any decision of race/event officials relative to my ability to safely compete or assist in this organization's activities. I assume all risks associated with running and/or volunteering to work in Club South Runners events including - but not limited to - falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the coarse, all such risks being known and appreciated by me. Having read this Club South Runners waiver and knowing these facts and in consideration of your acceptance of my entry for racing, I, for myself and for anyone entitled to act on my behalf waive and release the Road Runners Club of America, Club South Runners, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in these Club South Runners' activities, even though the liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use any photographs, motion pictures, recording, or any other record of my participation in any Club South Runners event for any legitimate purpose.

Signature ______________________________________________ Date _______________

Parents'/Guardians' Signatures __________________________ Date _____________