Panther Prowl 5K Glow Walk/Run
May 10, 2019 @ 8 PM - 10 PM
Email address *
First Name *
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Last Name *
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Street Address *
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City *
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State *
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Zip Code *
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Phone *
XXX-XXX-XXXX
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Gender *
Birthdate *
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Emergency Contact Name *
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Emergency Contact Phone *
XXX-XXX-XXXX
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T-Shirt Size *
Entry Fee *
If you choose the Early Registration, please drop payment off at the New Lexington Middle School office in an envelope labeled Panther Prowl 5K. You may also mail your payment to ATTN: Panther Prowl 5K, New Lexington Middle School, 2529 Panther Drive, New Lexington OH, 43764. Make checks payable to: NLMS Project Y.O.U.
Release and Waiver *
I know that running is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I also know that, although police protection might be provided, there could be traffic on the course route; therefore, I assume the risk of running in traffic. I also assume any other risks associated with running this event including, but not limited to, falls, contact with other participants, and the effects of weather and conditions of the road. I understand I am solely responsible for my own safety while traveling to and from or participating in this event. Knowing these facts and inconsideration of your acceptance of my entry, I hereby for myself, my heirs, executors, administrators, or anyone else who might sue on my behalf covenant not to sue, and waive, release, and discharge the sponsors or contributors to this event, any race officials, volunteers, the city and police agencies, their representatives successors or assignees from any and all claims of liability for death, personal injury, or property damage of any kind or nature whatsoever arising out of, or in the course of my participation . The release form and waiver extends to all claims of every kind or nature whatsoever, foreseen and unforeseen, known and unknown. The undersigned further grants full permission to use any photographs, video tapes, motion pictures, recordings, or another record of the event for any purpose. Minors will be accepted with a parent’s signature.
A copy of your responses will be emailed to the address you provided.
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