Salvisa Ruritan Club

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Male
Female

Age Category:

Youth - ages to 18 yrs.
Adult - ages 19 and UP

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Check this box & accept responsibility as stated: Complete and sign one entry form per person. RELEASE AND INDEMNIFICATION - READ BEFORE SIGNING: The signing of this entry blank and the participation in the Salvisa Ruritan Country Days Festival FUN RUN/ 5K RACE/Walk is with full knowledge of the risks involved therein and the undersigned individually and/or as parent or guardian assumes the risk of any injury, sickness or health defect including death, resulting from or received during participation in the races, and further releases and agrees to hold harmless the Salvisa Ruritan Club, its members, and board members, its committees, sponsoring and assisting agencies, and individuals from any liability, damage, claim or judgment that may result from or arise out of the participation of the participant in this race. I further recognize that participation in the Activity involves risk of injury to me, including possible short-term and long-term effects, disability, and even death. These risks can come from causes which are many and varied, may not even be presently foreseeable, and may include negligent acts or omissions of others. I grant permission to be photographed, video taped, & recorded for all media usage.