2008 Remembrance Run Entry Form
For pre-registration, please fill out the following form, and mail to: Mark Churchill, 46 Court St., Apt. 2
Morrisville, VT 05661

Last Name:________________ First Name: ________________ Age: ____       Male       Female   

Shirt size (circle one):   S    M    L   XL

Street address:________________________  

Town:______________ ZIP Code:_________

Phone #:_____-_____-______ Email:_________________

Bib #: ________________

(Make checks payable to Remembrance Run)
Release and Waiver
I, the undersigned, accept full responsibility for
myself and for any injuries that I may incur during the Remembrance Run. I have read this application and I fully understand that participating in this event maybe dangerous to my health. Sprained ankles and wrists, cuts, bruises, broken bones, hypothermia are all real possibilities. I fully understand that there may be no medical or emergency personnel on the course. I have trained sufficiently for this event. I am aware that there may be high-speed vehicles on the roads and road crossings. I will not hold any of the organizers, Peoples Academy, or any agency within the state of Vermont, or any volunteers responsible. My actions and mishaps are accountable to no one but myself.
I grant the race organizers the free use of my name
and any photos or videos of me for any use related
to the race they see fit. I acknowledge that my entry
fee is non-refundable, even if the race is canceled because of an act of nature or man.

 

Signature ___________________________
Parent or Guardian ________________________
Date ___/___/___
(If participant is under 18 then parent or guardian must also sign.)