Name: 

       Address: 

          City: 

         State:   Zip: 

         Phone: 

   Todays Date: 

 Date of Birth:   Age: 

    Shirt Size:   Child M L XL      Sex: M F

     Entry Fee: Adult $15 Kid 13 and under $10 before Oct. 2

I know that running is a potentially hazardous activity. I should not enter or run in club activities 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 run. I assume all risks associated with running in this race including, but not limited to, falls, contact with other participants, the effects of 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 acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release the organizers of the Leap for Discovery Creek, the Discovery Creek Children's Museum of Washington, Inc, its Board, staff and volunteers, and their representatives and sponsors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. Further, I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for legitimate purposes.

________________________________  ____________  ____________________________________

Signature                         Date          Parent's Signature if under 18

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