2nd Annual Monster Dash 2019
October 26th at 9am
Race will begin and end at The Family Wellness Center
Early Bird Registration
June 1st-Aug 31st 5K $15, 10K $20 - Registration fee
Sept 1st-Oct 4th: 5K $20, 10K $35
Late Reg -Oct 5th - Oct 16th: 5K $25, 10K $40
Email address *
Name *
Your answer
Age *
Your answer
Date of Birth *
Gender *
Phone# *
Your answer
Address: (Street, City, State, Zip Code) *
Your answer
T-Shirt size (early bird registrants ONLY) *
Agreement of Release and Waiver of Liability
By typing my full name at the bottom of this agreement, I hereby agree to the following: 1. That I am participating in the February Freeze Race, or alternate instruction during which I will receive instruction on running and fitness. 2. I understand that it is my responsibility to consult with a physician prior to and regarding my participating in the 5K race. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in this class. 3. In consideration of being permitted to participate in the 5K race. I agree to assume full reponsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program. 4. In consideration of being permitted to participate in the 5K race, I knowingly, voluntarily, and expressly waive any claim I may have the Ohio County Family Wellness Center, or any instructor for injury or damages that I may sustain as a result of particpating in the program. 5. I, my heirs or legal representatives forever release, waive, discharge, and covenant not to sue the Ohio County Family Wellness Center, or any associate/instructor of the 5K for any injury or death caused by their negligence or other acts. I have read the abover release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
Please type your full name to state your agreement to the terms and conditions above. (Parent must do so if child is under 18 years of age.) *
Your answer
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