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Name _________________________________________________ Age ______ Birth Date ___________ Gender: M F Street _______________________________________________ City _________________ State _____ Zip ________ Phone Number ___________________ Shirt Size: M L XL Check if applies: ___ Howard County Strider Fill in only if a member of a team: Team Name ________________________, Team Captain _________________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 offical relative to my ability to complete the run safely. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on any kind arising out of my participation in this event of 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 headsets are not allowed in the race and I will abide by this guideline.
_______________________________ _____________ _____________________________________ Signature Date Parent's Signature if under 18
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