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REGISTRATION IS CLOSED
THE FORM BELOW IS NOT VALID AS OF 4/22/16 5:45PM
Name
*
First
Last
Age (day of race)
*
Date of birth
*
Email
*
Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Which race are you registering for?
*
5K (all ages)
Walk
Kids Fun Run (ages 10 and under)
Tshirt Size
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
RELEASE: I, the undersigned, realize that running/walking a road race is a potentially hazardous activity. 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 safely completing the run. I assume all risks associated in running this event include, but are not limited to, falls, contacts with other participants, the effects of the weather, and road conditions; all such risks being known and approved by me. I agree to have images of me released to the media without compensation. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, by, myself, and anyone entitled to act upon my behalf, waive and release Firestone Park, the city of Columbiana, Heartland Christian School, race directors, volunteers, all sponsors and their representatives and successors from all claims of liability of any kind rising out of my participation in this event.
*
I agree
Please check the box below if you agree to the following.
Any questions?!
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Submit
✕
