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| Annual Dogwood Days 5K Run Idabel, Oklahoma Date: Saturday, April 3rd , 2010 Time: 5K Run - Registration 7:00 a.m. start 8:00 a.m. Start: East Main In Front of HOSS Building ( formerly Church of Christ) Entry Fee: $20 through April 1st $25 after April 2nd and day of race Registration: By mail through April 1st – P.O. Box 495, Idabel, Ok 74745 In person at Idabel Main Street Office, 100 East Main, Idabel – No Later Than April 1,2010 Race day, April 3rd, at 100 East Main in front of AEP/ PSO Building Awards: Medals- Men and Women - 12 & under, 13-19; and 5 year increments thereafter Up to 70 and over (places awarded in each group); Overall Male & Female Trophy AWARDS CEREMONY: Immediately Following Race *********************************************************************** ENTRY FORM AND WAIVER Name_____________________________________________________ Age _____ Address _______________________________________ Phone ______________ City__________________________________ State______ Zip________________ Male ( ) Female ( ) T-shirt Size: M ( ) L ( ) XL ( ) XXL ( ) 5K RUN T-Shirts Limited To First 40 Registered Runners Waiver: I know that running a road race is a potentially hazardous activity. I will not enter and run unless I am medically able and properly trained. I also know that although police protection will be provided, there will be a possibility of traffic on the course route. I assume the risk of running in traffic. I also assume any and all other risks associated with running in this event including, but not limited to, falls, contact with other participants, the effects of the weather, and the conditions of the roads, all such risks being known and appreciated by me. Furthermore, I agree to yield to all emergency vehicles. I am also fully aware that baby strollers, baby joggers, pushed wheelchairs and wheels of any kind (except competitive wheelchairs in a separate race, animals and headphones are strictly prohibited and I agree not to have them on the course. Furthermore, I agree not to return to the course after finishing. I am fully aware that allowing someone else to wear my race number, switching race numbers or running under a false name is a fraudulent act and I agree not to do this. Knowing these facts, and in consideration of your accepting my entry, I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue, and unconditionally waive and release and discharge the Idabel Chamber of Commerce & Agriculture, USATF, Oklahoma, LDR, City and State Police Department, dance officials, volunteers and any and all sponsors including any and all of their agents, employees, assigns or anyone acting for or on their behalf from any and all claims or liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or in the course of, my participating in this event whether same be caused by negligence or fault. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. The undersigned further grants full permission to sponsors and or agents authorized by them to use any photographs, video tapes, motion pictures, recordings or any other record of this event for any purpose. Applicants for minors will be accepted only with a parent or guardian’s signature. Participant____________________Parent/Guardian______________________________ Date signed: _____________________ Please make check payable and return to: Idabel Main Street Dogwood 5 K Run P.O. Box 495- Idabel,OK 74745 Amount Received $ _______ Date received: ________Cash _______ Check No. ________ Phone: (580) 208-2000, 933-6953 ( Faye House, Program Manager) Fax: (580) 286-5267 For office use only - Run # _____ |