Kirkland Town Library Third Annual .5K
Please fill out this form separately for each person participating.
Saturday, February 6 at 9 a.m. (**Please note the new date - we rescheduled due to cold weather**)
Name (one person per form - include a parent's name if under age 18) *
Phone number *
Email address *
Gloves are available for $5 per pair while supplies last. One size fits most adults.
Clear selection
Registration fee is $5 per person with a $10 maximum per family. Cost for participants without a library card is doubled. Cash or checks accepted. Make checks payable to Kirkland Town Library.
Drop off registration payment plus $5 for each pair of gloves ordered at the Kirkland Town Library or mail to: Kirkland Town Library, 55 ½ College Street, Clinton, NY 13323
WAIVER (read before signing) In consideration of you accepting this entry, I, the participant, intending to be legally bound do hereby waive and forever release any and all right and claims for damages or injuries that I may have against the Event Director and all of their agents assisting with the event, sponsors and their representatives, volunteers and employees for any and all injuries to me or my personal property. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees. I know that participating in this event is a potentially hazardous activity. I should not enter unless I am medically able to do so and properly trained. I assume all risks associated with participating in this event including, but not limited to: falls, contact with other participants, the effects of weather, traffic, and course conditions, and waive any and all claims which I might have based on any of those and other risks typical found in a road race. I acknowledge all such risks are known and understood by me. I agree to abide by all decisions of any event official relative to my ability to safely complete the run. I certify as a material condition to my being permitted to enter this race that I am physically fit and sufficiently trained for the completion of this event and that a licensed Medical Doctor has verified my physical condition. In the event of an illness, injury or medical emergency arising during the event I hereby authorize and give my consent to the Event Director to secure from any accredited hospital, clinic and/ or physician any treatment deemed necessary for my immediate care. I agree that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to medical transport, medications, treatment and hospitalization. By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to the above release and waiver. Further, I grant permission to all the foregoing to use my name, voice and images of myself in any photographs, motion pictures, results, publications or any other print, video graphic or electronic recording of this event for legitimate purposes.
Name of of participant (parent’s name if under 18 years of age) *
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