Official 2018 Reg Form .pdf
Original filename: Official 2018 Reg Form.pdf
Title: Official 2018 Reg Form
Author: Kristy Seeley
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Officer Tom Jr. 373 Run
5k-run/1 mile walk in memory of Officer Tom Cottrell Jr.
Sunday May 6, 2018
Danville High School Gym
Pre-Registration (guaranteed a shirt) $20 adult, $10 student (Ends April 27th)
Day of Event (limited number of shirts) $25 adult, $10 student
(Registration day of will be from 12-12:45 in the gymnasium)
Net Proceeds will benefit the Officer Tom W. Cottrell Jr. Charitable Fund
Checks are to be made payable to Community Foundation of Mt. Vernon and Knox County
Memo: Officer 373 Run
Pre-entries: Send to Ann Henry 9 Mermary Dr. Fredericktown, OH 43019
Donation only? Mail to Community Foundation of Mt. Vernon and Knox County, PO Box 309 Mount Vernon, OH 43050
Email__________________________________________Tshirt Size__________5K_____1mile walk________
I know that running/walking a good race is a potentially hazardous activity. I should not enter unless I am properly trained, medically able, and take into account any pre-
exsisting medical conditions. I assume any and all risks associated with this event includeing but not limited to: falls, contact with other participants, traffic, the effects of
the weather, 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 Danville Local Schools, the Village of Danville, and all other organizations
and persons connected with this event. They are not held liable or responsible for any injuries which I may suffer while taking part of this event, or as a result thereof. In
this connection, I hereby waive any claim for damages to my person or property. I grant full permission for organizers to use photographs, videotape or motion pictures
of me, and/or quotations from me in legitimate accounts and promotions of this event. No refunds are available. Event will be held rain or shine. I agree to the above
Parent/Guardian Signature (if under 18)_________________________________________________________