NAME:_______________________________________________________AGE:____________ ADDRESS:____________________________________________________________________ EMAIL:______________________________________________________________________ SHIRT SIZE: S M L XL
PAYMENT: CASH / CHECK (Make out to "Finger Lakes Land Trust") MEMBER OF A GROUP: NO / YES:_____________________________________________ ___________________________________________________________________________I know that running or walking a road race is a potentially hazardous activity. 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 or walking this event, including but not limited to, falls, contacts with other participants, the effects of the weather, including high heat or humidity, traffic and the conditions of the road, the possibility of collisions with vehicles, all such risks being known and appreciated by me. Having read this waiver, I, for myself and anyone entitled to act in my behalf, waive and release the Earth Day Bash 5k Organizing Committee, the towns of Ithaca and Dryden, Cornell University, the Finger Lakes Land Trust, Roots & Shoots, any race officials or volunteers, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I agree to withdraw from this event if so instructed by a race official. I grant the race organizers the free use of my name, and any photos or videos of me for any use they see fit. I acknowledge that my entry fee is non-refundable, including if the race is cancelled because of an act of nature or man.
I have read and fully understand the above acknowledgement of risk, release / indemnification and covenant not to sue. I have signed this document of my own free will, and agree to the terms outlined herein.
Signature:__________________________________________Date:___________________