2009 Westland Wild Dash 5k

Saturday, April 25, 2009, 8:30 a.m.

 

Entry Fee  $20 for adults, $10 for kids 18 and under, through April 17th;

                $25 for adults, $15 for kids 18 and under, from April 18th through Race Day

               

 Please mail & make checks payable to:

Westland PTA

5511 Massachusetts Avenue

Bethesda, MD  20816

 

Name____________________________________________________

 

 

Address__________________________________________________

 

 

City/State/Zip______________________________________________

 

Gender __male  __female

 

Age on Race Day______

 

Students at     __elementary school    __Westland    __other middle school   __highschool

 

Shirt size       __Kids large                __Adult small   __Adult medium   __Adult large   __Adult XL

 

Liability waiver must be signed by each participant.  Unsigned or illegible entries will be rejected.

Waiver:  I know that running a road race is a potentially hazardous activity.  I should not enter a race unless I am medically able and properly trained.  I agree to abide by any decision of a race official relative to my ability to safely complete the run.  I assume all risks associated with running this event, inlcuding but not limited to, falls, contact with other participants, effects of the weather, traffic and the condition of the road, all such risks being known and appreciated by me.  Having read this waiver and knowing these facts, and in consideration of you accepting my entry, I, for myself, and anyone entitled to act on my behalf, waive, relase and hold harmless all sponsors of the Westland Wild Dash 5k, the Westland PTA, Westland Middle School, Montgomery County Road Runners Club, Montogmery County, MD, USATF, and any public agency, theri representatives and successors from all claims or liability of any kind arising out of my participation in this event.

 

 

Signature/Date___________________________________________________________

(parent of guardian must co-sign if under 18)