February 7, 2015 Florala State Park ~ Florala, AL
Benefit RUN ~ Only 1st place in each category + Overall Male/Female/Walker/Runner
(please check) Runner ______ Walker ______ Race Begins at 9:00 a.m.
Name ________________________________________ phone#________________
Age on February 7, 2015 _____ Birth date __________ Male ___ Female ___
City __________________________ State__________ zip_________
Email Address ____________________________________________
Shirt Size:Youth 2T ___ 3T ___ Extra Small ___ Small ___ Med ____ Large ___ XL ____
Adult Small ____ Medium____ Large____ X-Large____ XXL____ XXXL ____
I know that running a road race is a potentially hazardous activity. I should not enter and run or walk unless I am medically able and properly trained. I assume all risks associated with running in this event including, but not limited to, falls; contact with other participants; the effects of weather, including high heat and/or humidity; traffic; and the conditions of the road, 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 my behalf, waive and release the officials, sponsors,the Cancer Freeze Board of Directors and the city of Florala from all claims or liabilities of any kind arising out of my participation in the Cancer Freeze 5K Run. I further state that I am in proper condition to participate in this event.
Signature (Signature of Parent/Guardian if participant is under 18)
Mail Entry To:
5k Cancer Freeze c/o Karen Johnson POB 524 Paxton, FL 32538
Registration $25.00 Make Check Payable to: Cancer Freeze
You may direct your 5k questions to: firstname.lastname@example.org
CALL or TEXT Karen 850-951-5385 Race Day Registration begins at 8:00 a.m