Champions of Hope 5K

Champions of Hope

5K Run

UNION UNIVERSITY

Saturday, September 1, 2012

8:15 AM

Name: ____________________________________________________________

Address: __________________________________________________________

            (Street)                                                                  (City, St, Zip)

Age on race day: ____ Gender: M or F  Phone: _________________________

Email: ______________________________T-Shirt size (with paid registration):         

Circle one:  XS    S     M    L    XL

Registration Fee 5K:     ___ $25.00             Payment information:     Cash     Check 

Additional T-shirts: ___$15.00 each

Make and/or return checks to

Livin-A-Dream, 56 Manor Road, Jackson, TN 38305

This year we will be raising money to support The Childress Foundation.

Liability Waiver must be signed to participate in the Champions of Hope 5K Run. I recognize that running a road race is a potentially hazardous activity. I should not enter and run/walk unless I am medically able and properly trained. I agree to abide by any decision of a race officials relative to my ability to safely complete the run. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of the weather, high heat and/or humidity, traffic 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 the organizers of the Champions of Hope 5K Run, its directors, officers, staff, and volunteers, the city of Jackson, TN and its employees, Jackson Roadrunners and its volunteers, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. Further, I grant permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purpose. For runner’s safety, I understand that headsets, bicycles, scooters, and roller blades are prohibited. Strollers and dogs (on a short leash) are allowed. I ALSO UNDERSTAND THAT THERE ARE NO REFUNDS FOR THIS EVENT.

Signature of participant or guardian if under 18 years of age: ___________________________________________

Date: _____________________