2008 5th Annual Valley Road Run Entry Form
(Please Print) Make check out to and send the Entry Form to : The Breathing Room Foundation
PO Box 287
Jenkintown, Pa 19046
Name_________________________________________ Sex_______ AGE on Race Day________
Address___________________________________________________________________
City____________________________ State___________ Zip_______________
Phone____________________________ e-mail_____________________________________________
Shirt Size____________ Registration Fee: $20
Waiver: I for myself, my heirs, administrators, and executor, waive and release all rights against the Breathing Room Foundation Inc,
Thomas J Paul Building, Abington Township, volunteers, sponsors, vendors, and any other association to the Valley Road Run. I waive all
my rights from injury I may receive from this event. I certify that I am in good physical shape and have trained for this race event and have
been cleared recently for exercise by a licensed physician. I issue permission to use my image for any future promotion of this event in print
or video.
Signature_______________________________________________ Date_______________________
(If athlete is under 18, parent or gaurdian must sign)
(Please Print) Make check out to and send the Entry Form to : The Breathing Room Foundation
PO Box 287
Jenkintown, Pa 19046
Name_________________________________________ Sex_______ AGE on Race Day________
Address___________________________________________________________________
City____________________________ State___________ Zip_______________
Phone____________________________ e-mail_____________________________________________
Shirt Size____________ Registration Fee: $20
Waiver: I for myself, my heirs, administrators, and executor, waive and release all rights against the Breathing Room Foundation Inc,
Thomas J Paul Building, Abington Township, volunteers, sponsors, vendors, and any other association to the Valley Road Run. I waive all
my rights from injury I may receive from this event. I certify that I am in good physical shape and have trained for this race event and have
been cleared recently for exercise by a licensed physician. I issue permission to use my image for any future promotion of this event in print
or video.
Signature_______________________________________________ Date_______________________
(If athlete is under 18, parent or gaurdian must sign)
