Name: __________________________________________ Age:________ Sex: ______ Shirt size: S M L XL 2X
Address: ________________________________________ City: __________________ State: _______ Zip: ________
Phone: ________________________ Emergency contact: ___________________________ Phone: ______________
Waiver: I, the undersigned, intending to be legally bound hereby waive any and all claims for myself, my heirs, executors, and administrators, against officials and/or sponsors of the Valdosta Sunrise Rotary Road Race/Walk or Kinderlou Forest for any reason whatsoever which may directly or indirectly result from my participation. I further state that I am in proper physical condition to participate in this event and grant full permission to any and all of the foregoing to use photography, videotape, motion pictures and or any other record of the event for any purpose.
Signature: _____________________________________________________
Date: ____________
Guardian signature if under 18: _____________________________________________________
Date: ____________
