Name________________________________________________________________
Age____________ Date of Birth _______________Sex____________
Street Address:________________________________________________________
City______________________________________ State_____________ Zip________
In consideration of the forgoing event, I for myself, My executor, Administrators, and Assigns, do hereby release and discharge the sponsors of the Jingle Bell 5K from all claims arising from this participation in the above named event. I am physically fit and have properly trained to participate in this event.
_________________________________________________________________
Signature (parent or guardian if under 18)
T-shirt size: ( ) med ( ) lg ( ) X-lg
