|
First Name
|
|
|
Last Name
|
|
|
Address 1
|
|
|
Address 2
|
|
|
City
|
|
|
Zip
|
|
|
State
|
|
|
Phone
|
|
|
Email
|
|
|
Gender
|
|
|
Birthdate
|
|
|
Age on Oct 13th
|
|
|
Juvenile Co-signer
|
Guardian Name
|
Distance
Marathon -
No Race Day Sign-ups
|
|
|
Shirt Size
|
|
Run for Charity
(Details)
|
Freedom's Run wants to help raise money for Non-Profit organizations (Tax Exempt 501-C3). You can choose to run for any one of the
above charities, or, Learn more about our program.
|
|
Waiver
In consideration of my application and permitting me to participate in this event, I hereby take action for myself and anyone entitled
to act on my behalf: (1) Waive, release and discharge from any and all liability from my death, disability, personal injury, property
damage, property theft or actions of any kind which might hereafter accrue to me including my traveling to and from the event, THE
FOLLOWING ENTITIES OR PERSONS: event coordinator, event director, event committee; The United States Government; including Harpers
Ferry National Park, Antietam Battlefield National Park, The C & O Canal National Park, The Town of Sharpsburg, The Town of Shepherdstown,
Shepherd University, volunteers, event sponsors, their directors, officers, employees, volunteers’ representatives, and agents, and
the event holders. I hereby agree to indemnify and hold harmless the entities or person mentioned in this paragraph from any and all
liability or claims made as a result of participation in this event, whether caused by the negligence or releases or otherwise.
|
|
|