7th Annual
Roseville Community Crime Stoppers
4th of July 5K Fun Run
2008
Registration Form
Please mail completed forms and make checks payable to:
Roseville Crime Stoppers
650 Douglas Ave.
Roseville, CA 95678 or
Last Name___________________________First Name________________________
Address________________________________________________________________
City_________________________State_______________Zip_____________________
Phone ( )_________________________E-Mail______________________________
Birthdate____________Sex_____________
How did you hear about this event?________________________________________
Please circle t-shirt size Adult (S) (M) (L) (XL) (XXL)
Youth (S) (M) (L)
The following release waiver must be signed by all participants
AGREEMENT, WAIVER & RELEASE
I, intending to be legally bound, for myself, my heirs, executors, administrators, waive and release any and all rights and claims I may have against J & J Sports Productions, Roseville Crime Stoppers, its agents, promoters and sponsors, and all persons, officials and organizations affiliated with the event for any and all injuries suffered by me while traveling to and from and while competing in this J & J Sports Productions event. I further attest that I am physically fit and sufficiently trained for this event. I, also give my permission for the free use of my name and/or photographs in any broadcast, telecast, newsprint or any other account of this event. I acknowledge I have read and fully understand my own liability and do accept the restriction. I have read and fully agree to the above.
SIGNATURE________________________________________DATE____________ PARENT/GUARDIAN IF UNDER18____________________________________