1st Annual Rebel

Baseball 5k Run/1 mile walk

Name:________________________________Male__ Female__

Age on day of race:____ DOB__/__/__ Email address:_________

Address:________________________Phone:_______________

City/State/Zip:________________________________________

T Shirt size (circle one) YL S M L XL XXL

Event (check one)___5k run___1 mile walk (no awards for walk)

Waiver
In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury
or accident which can occur while I am traveling to or frrm the event, during the event, or while I am on the
premises of the event. I am also aware of and assume all risks associated with participating in this event,
including but not limited to falls, contact with other participants, effect of weather, traffic and conditions of
the road. I, for myself and heirs and executors, hereby waive, release and forever discharge the event
organizers, sponsors, promoters, and each of the agents, representatives, successors, and assigns, and all
other persons associated with the event, for all my liabilities, claims, actions, or damages that I may have
against them arising out of or in any way connected with my participation in this event. I understand that
this waiver includes any claims, whether caused by negligence, the action or inaction of any of the above
parties, or otherwise. I also understand that the entry fee is non-refundable and non-transferable. .