I understand that my participation in the Rotarian Sponsored 5K/8K/10K Run/Walk is voluntary and that some physical risk is inherent in any physical activity.  For example, there exists the risk of injury from changes in physical condition, such as fatigue, an abnormal increase or decrease in blood pressure or heart rate, heart attack, stroke or death.  I agree to assume all risk associated with participating in this event, including but not limited to those physical conditions listed previously, falls, contact with other participants, effects of weather, traffic and road conditions.  Having read this wavier, knowing these facts and in consideration of acceptance of my entry, I for myself and for anyone entitled to act on my behalf, hereby release and discharge both the Rotary Club of Smithville and the Smithville Chamber of Commerce, and their respective officers, directors and employees from all claims, damages and liability that I may have against them arising from my participation in all activities relating to the Rotarian Sponsored 5K/8K/10K Run/Walk.  This release and waiver extends to all claims of any kind or nature whether foreseen, known or unknown.

 

__________________________________________ Signature of Participant

__________________________________________ Signature of Parent or Guardian if Under 18 Years of Age.

  Name

Address

  City, State, Zip                                                            

                                                            

Date of Birth         /        /                    Gender:      M      F        Age _________