************************************************************************************

REGISTRATION FORM

NAME___________________________________________________________ F ___M___

AGE ON RACE DAY _________________________ MY FIRST TRAIL RUN: YES___ NO ___

ADDRESS _________________________________________________________________

_________________________________________________________________

I RUN BECAUSE ____________________________________________________________

*************************************************************************************

WAIVER

I know that running a trail race is potentially hazardous activity and I should not enter and run unless I am medically able and properly trained. I agree to abide to by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event including, but not limited to: fall, contact with other runners, the effects of weather (such as high heat and/or humidity), traffic, and the conditions of the trail, all such risks being known and appreciated by me. Having read this waiver, I, for myself and anyone entitled to act on my behalf, waive and release the VHTRC, Northern Virginia Regional Park Authority, and all other sponsors, their representatives and successors, from all claims and liabilities of any kind arising out of my participation in this event, or carelessness on my part of the persons named in this waiver. Further, I grant permission to all of the foregoing to use any photographs or any other record of this event for any legitimate purpose.

SIGNATURE _________________________________________ DATE ____________________

(If runner under 18, parent or guardian must sign)