Cider Shuffle 5k Run/Walk - Registration Form
Please fill out this form to register for the Cider Shuffle 5K Walk/Run at the Missisquoi Valley Rail Trail. COST: $15 to register. Payments can be made in person or sent by check in the mail to the Enosburgh Town Clerk's Office.

To pay in person go to 239 Main Street Enosburg Falls, VT 05450
To pay by mail send check to P.O. Box 465 Enosburg Falls, VT 05450.
Checks can be made out to Town of Enosburgh.

For more information, please email recdirector@enosburghvt.org.
First Name *
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Last Name *
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Date of Birth (mm/dd/yyyy) *
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Age on Race Day
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Phone *
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Address
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Town/State *
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Sex
Emergency Contact *
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Emergency Contact Phone *
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Medical Concerns/Allergies
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Runners Primary Care Physician
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Primary Care Physician's Office Number
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Participant Waiver: I know that running a road race is potentially hazardous activity, which could cause injury or death. I will not enter and participate unless I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this event, and am in good health, and I am properly trained. I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I attest that I have read the rules of the race and agree to abide by them. I assume all risks associated with running in this event, including but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road and sidewalks, and all such risks being known and appreciated by me. I understand that bicycles, skateboards, roller skates or roller blades, and animals are not allowed in the race and I will abide by all race rules.Personal music players are allowed at the runner’s own risk. For myself and for my heirs, personal representatives and assigns, I hereby release the Town of Enosburgh, Vermont, their principals, directors, officers, agents, employees and volunteers, and their insurers, (collectively hereinafter “Town of Enosburgh”) from any and all claims, demands, actions, causes of action, suits in equity of whatever kind or nature, and from any and all liability of any nature for any and all injury or damage (including death) to me and any other persons as a result of my participation in the activity, regardless of the cause. I understand that this release includes any claims based on negligence, action or inaction, of any of the above parties. I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record of this event for any legitimate purpose. I understand that this event does not provide for refunds in the event of cancellation, and by signing this waiver, I consent that I am not entitled to a refund if the event is cancelled before or during the event. *
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If participant is under 18, please include parent/guardian name.
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