2016Gobble Wobble RunOfficial Entry Form

WHEN

Saturday, November 12, 2016 at 9:00am

Late registration 8:00am-8:30am

5K: 9:00am

LOCATION

Starts and Finishes at West Middle/High School

ENTRY FEES:

$20Registration Fee Due Oct31st

$25Late Reg. (Nov 12th)/Day of Race

ENTRY FEE includes:

Short sleeve shirt and refreshments after the race including fresh fruit, water, Gatorade, and power bars

AWARDS

Awards will be presented to 1st overall male & female and top 3 in age groups: 12 & under, 13-18, 19-29, 30-39, 40-49, 50-59, 60 & over

PLEASE PRINT CLEARLY

Name:
Address:
City, State, Zip:
Email:

Make Checks Payable to:Mail Entries to:

West Middle School West Middle School

1008 Jerry Mashek

Drop off Entry form at:West, TX 76691

West Middle School

Questions: Contact Jonathan Shaw at

RELEASE AND INDEMNITY

I, the undersigned below, in consideration of my and/or the named Participant's participation in the West Middle School Gobble Wobble ("Event"), acknowledge that I am aware that my or the Participant’s participation in the Event may result in risks, which among other things, include but are not limited to contact with Event participants or volunteers or with vehicles; scrapes; bruises; twisted ankles and various injuries to the body, including death and heat and stress related issues. I further acknowledge that I freely assume on my own and/or the Participant's behalf all risks incidental to such participation.

In consideration of my and/or the Participant’s participation in the Event, on my own behalf and on behalf of the Participant, I hereby voluntarily waive, release, covenant not to sue, and forever discharge the Released Parties (as defined below) of and from all liabilities, claims, actions, damages, costs and expenses of any nature arising out of, related to, or in any way connected with my participation and/or the Participant’s participation in the Event and/or any such related and associated activities. This release extends to and includes any and all claims, actions, damages, costs and expenses arising out of or related to any act or omission constituting negligence or gross negligence on the part of any of the Released Parties. In further consideration, I agree to indemnify and hold each of the Released Parties harmless from and against any and all such liabilities, claims, actions, damages, costs and expenses up through and including any appeal, including but not limited to claims based on negligence or gross negligence, bodily injury (including, without limitation, death), property damage, and loss by theft or otherwise, whether suffered by me or my child either before, during or after such participation, including the travel to and from the Event.

I further understand that as a parent or legal guardian of the Participant, I may be responsible if the Participant causes bodily injury to other individuals, causes property damage to personal or real property, or engages in conduct that gives harmed individuals the right to restitution. I hereby agree to indemnify and hold harmless the West Independent School District, its trustees, employees, and agents, in both their official and individual capacities, from any and all claims made by third parties against it or them resulting from the Participant’s actions on and during this Event.

I further declare that I (if participating) and/or the Participant are physically fit and have the skill level required to participate in the Event and I authorize medical treatment for me and/or the Participant at my cost, if the need arises.

For the purposes hereof, the "Released Parties" are: West Independent School District, as well as its officers, trustees, employees, and agents in both their official and individual capacities; the City of West; and Event sponsors, including their parent companies, subsidiary, and/or affiliated and related entities of each of them; and collectively the trustees, officers, directors, employees, and volunteers of any named Released Parties.

Date______Signature______

Signature of Parent/Guardian______