Run for Refugees 5K
February 4, 2018
Until 12/1 / 12/2 – 12/31 / 1/1 – 2/3 / Raceday5K
(Adult) / $25 / $30 / $32 / $35
5K
(18 & under) / $15 / $20 / $22 / $25
______5K )
¨ I receive complimentary entry for raising $200 or more for IRIS
Amount Owed: $______
Additional Donation: $______
Total: $______
Checks Payable To: IRIS
2 Buena Vista Road
Branford, CT 06405
Last Name First Name
Address
______
City State Zip
______¨ Male ¨ Female / /
Age Date of Birth
WAIVER: I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I also know that although traffic will be restricted, there will be traffic on the course route. I assume the risk of running in traffic. I agree to abide by any decision of any race official as to my ability to safely complete the run. I also assume any and all other risks associated with running this event, including but not limited to, falls, contact with other participants, effects of the weather, including high temperatures and/or humidity, thunder, lightening, wind, rain or freezing rain, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf waive and release the City of New Haven, JB Sports LLC, John Bysiewicz, any race organizing committees and/or board of directors, IRIS, U.S.A. Track & Field, race officials, volunteers, and all sponsors including their agents, employees, assigns or anyone acting on their behalf, from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. Application for minors under 18 will be accepted only with a parent's signature.
______
Signature (Parent must sign if competitor under 18) Today’s Date