Buckeye Blitz 5K
Tuesday, July 21, 2015
Registration Form
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5k T-shirt logo
Which best applies to you? *
Name *
Address *
City *
State *
Zip Code *
What does your registration include?
The Registration fee for the Buckeye Blitz 5k is $25 and includes a moisture wicking shirt, finisher's medal, pancake breakfast and goodie bag.

Please send your check to:
 
The Buckeye Blitz 5k
10514 Winchester Road
Canal Winchester, Ohio 43110
Email *
Phone Number *
Shirt Size *
Please designate Men's or Women's style shirt
Barn/Team Name
If Applicable
I HAVE READ AND AGREE TO THE FOLLOWING WAIVER OF LIABILITY *
By participating in this event, I, the undersigned, do so at my own risk. I assume all risk of injury, illness, damage or loss to me, my pet, or my property that might result. I agree on behalf of myself (and my personal representatives, heirs, executors, administrators, agents and assigns) to release and discharge the organizers of the Buckeye Classic, the Buckeye Blitz, OQHA/OAQHA, BWHA, their principals, officers & directors, volunteers, employees, all sponsors, and their representatives for any and all injuries and/or death suffered by me or my dog (if applicable) in said event. I attest and verify that I know running road races can be a potentially hazardous activity. I consent to medical treatment in the event of injury, accident and/or illness during the event. However, I have sufficiently trained for the completion of this event and know I am running/walking at my own risk. I am also aware of the danger of racing/walking in hot weather and on varied surfaces. I have read this waiver of liability. Additionally, I hereby grant full permission to use my name and likeness in any promotion of the event without compensation.
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