Shamrock Run 5k/1 mile Registration Form and Waiver

First Name (required)

Last Name (required)

Phone number (required)

Email Address (required)

Age (required)

Emergency contact name and phone number (required)

Race Selection (required)

5k (3.1 miles)

1 mile

T-shirt size (Adult and youth,limited quantity not a guarantee)) (required)

I know that I am participating in a potentially hazardous event. I will not enter and participate unless I am medically able and properly trained. I agree to abide by any decision of any race official as to my ability to safely complete this event. I assume all risks associated with the event, including but not limited to fall, contact with other participants, effects of weather including high heat and humidity, traffic and the condition 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 Stoddard County Ambulance, the City of Dexter, the Stoddard County Children's Home, race officials, volunteers and all sponsors from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all foregoing to use any photographs, motion pictures recordings or any other records of this event for any legitimate purpose. I know that dogs, bicycles, in line skates, skateboards are not allowed on the course. (required)

I am 18 years of age or older

I understand and agree to waiver and consent.

$25

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