| Entry form for the 38th Annual Schuylkill River Loop Run /8.4 Miles Philadelphia's Oldest Road Race Saturday, November 12th, 2011 (Please Print) Name: ___________________________________________________________ Address:____________________________________________________________ City _______________________ State________ Zip ______________ T-shirt size_____ Phone_________________________ Sex_________ Age on Race Day____________ Schuylkill River Loop : $25 by 11/05/11 $30 after 11/05/11 Make Check Payable to : Philadelphia Athletic Charities and Send to 611 Jamestown Street Philadelphia Pa 19128 Release Waiver: I know that running a road race is a potentially hazardous activity. I vow that I am medically able and properly trained for the race I am entering and I assume any and all of the risks associated with an event of this nature. I agree that bikes, strollers, and animals are not allowed in the race and I give permission to the Schuykill River Loop race to use my image for any promotional purpose. I hereby for myself, my heirs, & executors, or anyone who may claim on my behalf and agree not to hold Philadelphia Athletic Charities, the City of Philadelphia or any sponsor, volunteer or organization associated with the Schuylkill River Loop Race from any claims of liability for death, injury or property damage. Signature________________________________________ Date_______________ (Parent or Gaurdian if athlete is under 18 years old) |
