Phone:__________________________ E-Mail:______________________________________ Age on race day:_________ Sex:______ T-shirt size: S - M - L - XL
Waiver: In the consideration of the acceptance of the entry, I hereby waive and release any and all rights and claims for damages and injuries which I may have against all persons and entities involved in the event while participating in the LeRoy Old Home Day 5K Race. I attest that I am physically fit and prepared for this event. SIGNATURE:___________________________________ SIGNATURE OF PARENT/GUARDIAN:___________________________ DATE:_____________________________
*Click on "PRINT FRIENDLY VERSION" Before printing.