Appalachian Outfitters' - Wild Bear Adventure Race – June 29th, 2003

WAIVER / HOLD HARMLESS CONTRACTUAL AGREEMENT: By signing this contractual agreement I acknowledge the fact that participating in the Wild Bear Adventure Race is a potentially hazardous activity and I am competing with full knowledge of all potential risks and injuries. I will not enter and race unless I am medically able and properly conditioned and trained for the level of competition that I aspire to. I also know that, although, some safety protection via course officials will be provided, there can be many hazards on the course route. I also assume any and all other risks associated with this event including but not limited to falls, contact with other participants, the affects of weather, including high heat and or humidity, the condition of the roads and all risks being known and appreciated by me. Knowing these facts, and in consideration of your accepting my entry, I hereby for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, convenant not to sue, and waive, release and discharge Breakaway Sports, Officials of the event and any other sponsors or associated organizations, including their Police Department; Emergency Radio Systems; Race Officials, Volunteers, or any of the employees, agents, assignees or anyone acting on or for their behalf, from any and all claims or liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or the course of, my participation in this event known as the Wild Bear Adventure Race. All costs incurred for medical assistance, be it ambulance, hospital, etc., is my sole responsibility and my financial liability. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. The undersigned further grants full permissions to the race organizers, sponsors, producers, and directors and or agents authorized by them, to use any photographs, videotapes, motion pictures, sound recordings, or any other record of this event for any purpose, be it promotional for remuneration to the aforementioned parties, without financial or other compensation or royalties to the event participant named herein. Applicants understanding and agreeing to this Waiver / Hold Harmless Contractual Agreement as specified herein and the rules of the event and decision of race officials should sign the entry form on the space provided below. I also agree that I am signing this contract and am competing for consideration of medals, awards and or prizes as named for the event.

Signature of Participant: X ____________________________
Date: _________

Participant Information – Please Print LEGIBLY

Last Name: _________________________________   First Name:___________________________________

Address: _________________________________City: __________________________State:___ Zip:________

DOB: ________ AGE: ____ SEX:_____ Phone #: ________________

 Email:____________________________________

Team Name:_________________________Captain:_________________________

Pick One:

Pick One:

 Gear Transfer Needed?
2 Per. Team MALE FEMALE COED MASTER   ***Yes            No
4 Per. Team MALE FEMALE COED MASTER   ***Yes            No

 

PLEASE ***CIRCLE DESIRED SHIRT SIZE:     S      M      L       XL       XXL

Make entry check payable to: Breakaway Sports and mail entries to:
***Please add $10.00 for gear transfer and each additional shirt other than team members.

BREAKAWAY SPORTS, Wild Bear Adventure Race @ PO BOX 631, SHILLINGTON, PA 19607
Question call: 610-775-9776, or email us at: ibulrich@aol.com, or access our web site at: http://www.makebreak.com