LANDECK 5K TURKEY TROT FOR TECHNOLOGY REGISTRATION FORM

NAME: ________________________________________________________ AGE: __________ (circle) M F

ADDRESS: _______________________________________________________________________________________ EMAIL: __________________________________________________________________________________________ PHONE: _________________________________ SHIRT SIZE: (Circle One) S M L XL

PRE-REGISTRATION FEE: $25.00 (includes Dri-Fit shirt) by November 15th REGISTRATION FEE: $20.00 (no shirt) between November 16th and race day *No refunds and will not be rescheduled if canceled due to bad weather! Mail registration form and payment to Schrader Realty c/o Landeck Turkey Trot, 202 N. Washington St, Delphos, OH 45833. Make checks payable to Landeck Parents Club! Call Krista Schrader 419-233-3737 with questions!
WAIVER AND RELEASE I agree that by participating in the Landeck 5K Turkey Trot for Technology, I do so at my own risk. I assume all risk of injury, illness, damage or loss to me or my property that may result, including without limitation, any loss or theft of personal property. I consent to medical treatment in the event of injury, accident and/or illness during the Landeck 5K Turkey Trot for Technology. In exchange for accepting my entry fee, I agree to be legally bound, for myself, my heirs, next of kin, executors, and administrators, and voluntarily assume all risks of accident or injury and release and forever discharge, indemnify and hold harmless Landeck 5K Turkey Trot for Technology, Landeck Elementary School, its officers, employees, members, representatives, agents, volunteers, and/or sponsors (Released Parties) from any and all liabilit y for personal injury or property damage of any kind sustained during the Landeck 5K Turkey Trot for Technology whether such personal injury or property damage is caused directly or indirectly by the Released Parties. I have full knowledge of the risks involved and attest that I am physically fit and sufficiently trained to participate in the 5K. I further give permission to Landeck 5K Trot for Technology and their committee members the right to use my photography. ______________________________________________________________________ Participant Signature (read above and sign here) EMERGENCY CONTACT INFORMATION; NAME: _______________________________________________________________ PHONE: __________________________ ___________________ Date

As a parent/guardian on behalf of the above-named minor, I have read the above terms of this Agreement, and I understand and agree to the terms and conditions stated herein. This Agreement/Release shall be binding upon the heirs, administrators, executors, and assigns of the undersigned. I further agree to indemnify Landeck 5K Turkey Trot for Technology, its agents, officers and employees against any action brought against by the above-named Participant, including but not limited to an action brought by him or her upon reaching the age of majority. I warrant that I am authorized to execute this Agreement and Release on behalf of the above-named minor. _______________________________________________________________________ Parent/Guardian Signature (read above and sign here) ____________________ Date