Name: 

      Address: 

         City: 

        State:    Zip: 

        Phone: 

       E-Mail: 

 Today's Date: 

Date of Birth:    Age on race date: 

       Gender: M F   Shirt Size: M L XL

    Entry Fee: $ 35 before Aug. 7 $40 After Aug. 7  

Waiver Must Be Read and Signed Before Mailing:

I acknowledge that this athletic event is an extreme test of a person's physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby assume all of the risks of participating and/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault. I certify that I am physically fit, have sufficiently trained for participation in the event and have not been advised otherwise by a qualified medical person. In consideration for my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) waive, release, and discharge from any and all liability for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter accrue to me including my traveling to and from this event, the following entities or persons: Frederick Community College, their directors, officers, employees, volunteers; (B) indemnify and hold harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this event, whether caused by the negligence of releasees or otherwise.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during this event.
I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and/or assigns.
Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I hereby certify that I have read this document and I understand its content.

_______________________________

Parent Name

_______________________________  _____________ _____________________________________

Signature                        Date          Parent's Signature if under 18

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