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SOUTHERN CALIFORNIA ROAD RUNNERS

PRESENT A      4TH OF JULY 5K RACE

firecrackersRUN OR WALK  firecrackers

1ST ANNUAL RACE TO SUMMER CAMP

Location:  Valley Blvd & Grand Ave City of Industry (next to McDonalds) Race/Walk Start Time 8:00am

 

Registration Time: 6:30am to 7:45am          $20.00 includes a T-shirt       $18.00 Fun Walk includes T-shirt

No Late Fee – Race Day Registration O.K.

Cash Prize to Top 3 Over-All Male & Female winners   ($75.00 1st Prize, $50.00 2nd Prize, $25.00 3rd Prize)

Top 3 in each age division will receive a medal award

Course – 95% flat out and back

 

 

Text Box: (Please Print) First Name: _________________________________________ Last Name _____________________________________ Address: ___________________________________________ Phone: (____) __________________________________ City _________________________________ State: _________ Zip: Female ¨ Male ¨ Age on Race Date: _________ Race ______ Fun Walk _______ 10 and Under ¨ 11–13 ¨ 14-17 ¨ 18-24 ¨ 25-29 ¨ 30-34¨ 35-39 ¨ 40-44 ¨ 45-49 ¨ 50-54 ¨ 55-59 ¨ 60-69 ¨ 70 and over ¨ Waiver: In consideration of your accepting my entry, I the undersigned, intending to legally bind myself and my heirs, executors, administrators, next of kin and assignees, do hereby waive any and all rights and claims against any person or organization affiliated with this race. I agree to indemnify and hold harmless the SOUTHERN CALIFORNIA ROAD RUNNERS OF WALNUT, officials, the race organizers and any and all sponsors from any claims, actions, damages, liability and expenses, including attorney’s fees, on account of injury to my person or property or resulting in my death while I am competing, observing or participating in any way in this event, including travel to and from the race. I further attest that I am physically fit and have been sufficiently trained for the race that I am entering and that my physical condition has been verified by a licensed medical doctor. ___________________________ ________________________________ ___________ Signature Parent Signature if Participant is under 18 Date
Text Box: Waiver: In consideration of your accepting my entry, I the undersigned, intending to legally bind myself and my heirs, executors, administrators, next of kin and assignees, do hereby waive any and all rights and claims against any person or organization affiliated with this race. I agree to indemnify and hold harmless the SOUTHERN CALIFORNIA ROAD RUNNERS OF WALNUT, officials, the race organizers and any and all sponsors from any claims, actions, damages, liability and expenses, including attorney’s fees, on account of injury to my person or property or resulting in my death while I am competing, observing or participating in any way in this event, including travel to and from the race. I further attest that I am physically fit and have been sufficiently trained for the race that I am entering and that my physical condition has been verified by a licensed medical doctor. ___________________________ ________________________________ ___________________________ Signature Parent Signature if Participant is under 18 Date is Under 18 is Under 18 physical condition has been verified by a licensed medical doctor. ___________________________ ________________________________ ___________________________ Signature Parent Signature if Participant Date