First Name : *
Last Name : *
Street :
City :
State : *
Age (day of the race) : *
Gender : *
What’s Your T-Shirt Size : *
Phone Number :
Email : *
I know that running / walking a road race is a potentially hazardous activity and that I should not enter unless I am medically able and properly trained. I agree to abide by any race official relative to my ability to safely complete the run. I assume all risks associated with this event including but not limited to falls, contact with other participants, the effect of the weather, including high or low temperatures and or humidity, traffic and other conditions of the course; all such risks being known and appreciated by me. Having read this waiver and accepting these facts and in consideration of accepting this entry, I the undersigned, intending to be legally bound hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for losses and damages I may have against Living in Freedom and Empowerment, Inc. (LiFE), the Christian Coalition Against Domestic Abuse, Inc. (CCADA) any and all sponsors, their officers, directors, members, and volunteers, other parties and their representatives, successors and assigns for any and all injuries suffered by me in said event. I attest that I am physically fit and am voluntarily participating in this event at my own risk. Further, I hereby grant full permission to any and all foregoing to use photographs, video-tapes, motion pictures, recordings or any other record of this event for any purpose whatsoever.

By selecting Yes,
You Agree with the Terms
of the 5K Walk/Run Participant Waiver *