Registration - Step 1

Your Name

Phone Number

Mailing Address

Email Address

List any medical problems or other concerns:

I will be participating in the

Shirt Size (must be registered online by September 25th, 2015)

I, the undersigned accept this entry and registration as a participant in the Special Delivery Costume Party 5k and walk/run and waive any and all claims which I and my heirs or assigns may now or hereafter have against Special Delivery Adoption Agency or Maxwell’s Pumpkin Farm. I assume all risks associated with this running/walking event, included but not limited to falls, contact with other participants, effects of weather, traffic, or conditions of the roads. I warrant and represent that I am in proper physical condition in order to participate in the run/walk and am not participating in this event against physicians advice or that I am taking medications that would impair my health and ability to participate in the run/walk, if runner/walker is under age 18 I hereby give permission for my son/daughter to participate in the Special Delivery Costume 5k ru/walk and officials have my permission to provide emergency treatment if necessary.

Name

Date

Initials (Parent Initials if entrant under 18)