2017 PRINTABLE ENTRY FORM

(solo, relay, and free kids races)

Mailed by Feb. 15th, 2017 -- $25 team and $15 individual                   After Feb. 15th, 2017 and Day of Race -- $35 team and $20 individual

Please check all that apply:

___ Solo division  (Only fill out Runner #1 info below)

___ Female-Female                  ____ Same school        School name: ______________________

­­­___ Male-Male                          ____ Family team        Relationship: ______________________

­­___ Male-Female                      ____ Married team      Number of years married: ______

            Combined age: __________

Runner #1 (Contact info below)

Name: ________________________________

Age: ________ Sock size: S M L XL

Runner #2 (may run 1st or 2nd)

Name: ________________________________

Age: ________ Sock size: S M L XL

Phone: _______________________________

Address: ______________________________

______________________________________

email: _________________________________

Waiver Release: I hereby certify the following: (1) I am medically able and properly trained to participate in the ROAD-odend-RUN; (2) I further agree in the event of an injury or accident that event officials may authorize necessary treatment for me and I further authorize the American Medical Response (AMR), Olympia Fire Dept. (OFD) or any other medical treatment provider to furnish to the event organizers my name, telephone number, and if applicable, the name of any hospital or medical facility I was transported to as a result of any injury or medical problem that arose out of this event; (3) I further grant the ROAD-odend-RUN specific permission to reproduce, publish, circulate, copyright, or otherwise use an and all photographs and/or videotape of me and/or my family, taken at the event; and (4) Having read this waiver and knowing these facts, and in consideration of the acceptance of my entry into this event, I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue, and waive, release and discharge all subsidiaries, affiliates, assigns, representatives and successors of the foregoing: The City of Olympia, Olympia Police Department, Olympia Fire Department, and all event sponsors, suppliers, agents, independent contractors, employees and any other personnel in any way assisting or connected with the ROAD-odend-RUN from any and all claims of liability of any kind whatsoever

Entries cannot be accepted without a valid signature. Entries from minors will only be accepted with a parent or legal guardian’s signature.

 

Signature #1_______________________________ Date _______

 

 

Signature #2 ______________________________ Date _______

 

Mail Entry form to:

ROAD-odend-RUN

5129 Chambers Creek Loop SE

Olympia, WA 98501

Or register at the Olympia South Sound Running Store January 2nd – February 18th (4:00 PM) , 2017

Make checks payable to Jesse Stevick

(any race proceeds will go towards promoting especially youth running in the Olympia area)

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