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Color X-treme 5K Fun Run 2014 Registration
Contact Information:
First Name:
Last Name:
Email:
Phone:
Address:
Street:
City:
State:
Zip:
Gender:
Date of Birth: ** anyone under 18 must have parental consent
dd/mm/yyyy
Shirt Size:*
Team Name (if you are part of a team please include team name - up to 6 members constitute a team):

Emergency Contact:
First Name:
Last Name:
Phone Number:
Waivers and agreements (Please check that you have read and understand all the items below):*
In consideration for accepting my entry in this race, I for myself, my heirs, executors, and administrators, waive and release forever any and all rights and claims for damages I may incur as a result of participating in this event against the organizers and sponsors of this event, the Commonwealth of Virginia, Virginia Highlands Community College, the Virginia Community College System and their respective officers, employees, and agents. I also release the above named for all claims of damage demands, and actions in any manner due to any personal injuries, property damage, or death sustained as a result of my traveling to and from and my participation in said race. I attest and verify that I am medically and physically able to participate in this event. In filling out this form, I acknowledge I have read and fully understand my own liability and ability.
Strollers and pets are not allowed on the course.
By entering my name below, I assert that I have reviewed and agree to all the waivers and agreements I have selected above.
Electronic Signature: (First and Last Name)

** Parent consent form is required if participant is under 18. Please contact the college at (276)739-2434 for consent form.
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