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Tour de Potsdam 2012

First Name

Last Name

Phone Number

Your age on 7/12/2012

Gender

/FemaleMale

Race

5K Walk5K Run

T- Shirt Size

Waiver

Waiver:  I know that running or walking is a potentially hazardous activity.  I should not enter and run or walk unless I am medically able and properly trained.  I agree to abide by any decision a race official relating to my safety and/or ability to safely complete the walk/run.  I assume all the risks associated with walking/running in this event including but not limited to: falls, contact with other participants, the effects of weather, including high heat and/or humidity, traffic and conditions of the roads, all these risks being known to me and appreciated by me.  Having read the preceding 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 Village of Potsdam, the Potsdam Chamber of Commerce, the St. Lawrence Health Initiative, and the organizers, workers 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 and described in this waiver.

Photo Release: I hereby irrevocably consent to and authorize the use and reproduction by the St. Lawrence Health Initiative, Inc. or anyone authorized by them, of any and all photographs, video, or films which you have this day, the 12th of July 2012, taken of me, my child or my property for the said purpose of agency publicity.  I understand there will be no compensation from any source for the use of any photographs, videos, or films taken of me, or my property.

By checking this box I acknowledge that I have read and accept this waiver on behalf of myself or my minor child.

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