Run for
Registration begins at
(fill out completely, print
clearly, one entrant per form, use of copies OK)
________________________________________________________________M/F
First
Name MI Last Name Date of Birth Sex
___________________________________________________________________
Mailing
Address City, State, Zip e-mail address
___________________________________________________________________
Area Code
& Daytime Phone Evening Phone
age as of
READ THIS! I know that participating in a natural trail run/walk race is a
potentially hazardous activity. I should
not enter and run/walk 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 event. I
assume all risks associated with participating in this event including, but
not limited to falls, contact with other participants, the effects of weather,
including heat, rain and/or high humidity, traffic and the conditions of the
road, the woods and nature, all such risks being known and appreciated by
me. Having read this waiver and knowing these facts
and in consideration of acceptance of my entry, I, for myself and anyone entitled
to act on my behalf waive and release Bridle Trails Park Foundation, the City
of Kirkland, the City of Bellevue, the State of Washington and King County,
all sponsors and event organizers, their representatives and successions from
any and all claims or liabilities or any kind arising out of my participation
in this event even though said liability may arise out of negligence or carelessness
on the part of the persons named in this waiver.
I grant permission for all of the foregoing to use any photographs,
motion pictures, recordings or any other record of this event for any legitimate
purpose. This is to certify that my child has permission
to compete in this event, is in good physical condition and that event officials
may authorize necessary emergency treatment. ENTRIES CAN NOT BE ACCEPTED WITHOUT A VALID
SIGNATURE!
Participants Signature____________________________________,
Date: __________
Parent’s
Signature _______________________________________, Date: ___________
(if participant is under 18 years of age)
Make Checks Payable to:
Mail by
Questions:
206-459-2664, dugoni@msn.com
Entry Fees:
______5k Walk/Run: $20; ($25 if Day of Event Registration)
______10k Walk/Run:
$20; ($25 if Day of Event
Registration)
Non Refundable Entry Fee $______
*Add. Contribution to BTPF $______
Total $______
*Does your employer
match contributions? Yes___, No____. If so, which Company ______________ and please attach employer matching form. For any
donations over $250 you will be mailed a tax deduction receipt.
How did you hear about us? friend, website, run brochure, runners
magazine (please circle), other: ___________
Is this your first visit to Bridle
Trails? Yes/No (please circle)