Name:      Chip Owner Chip#:  
      Address: 

         City: 

        State:    Zip: 

        Phone: 

       E-Mail: 

Date of Birth:    Age on race date: 

       Gender: M F  Howard County Strider: Yes No 

   Shirt Size: M L XL    

    Entry Fee: $22 online through April 15 $28 through April 16 $30 on race day

I know that running a road race is a potentially hazardous activity and I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to complete the run safely. I assume all risks associated with running this event, including, but not limited to, falls, contact with other participants, the effects of weather, traffic, and the conditions of the road and traffic on the course all such risks being know and appreciated by me.  Having read this waiver and knowing these facts and in consideration of your accepting this entry, I for myself and anyone else entitled to act on my behalf, waive and release Clyde's Inc., the Howard County Striders Inc., and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event or carelessness on the part of the persons named in this waiver. Further, I grant permission to all of the foregoing to use photographs, motion pictures, recordings, or any other records of these events for any legitimate purpose.  I understand that bicycles, skateboards, baby joggers, roller skates or blades, animals, and radio headphones are not allowed in the race and I will abide by this guideline.

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Signature                        Date          Parent's Signature if under 18