Race for Recovery
Coast Rocks and Runs
 

2 Mile Run           2 Mile Walk         ½ Mile Run    (Check One)

T-Shirt Sizes

Youth Small            Youth Medium        Youth Large                Adult Small  

 Adult Medium           Adult Large             Adult XL  

Name
Address
Telephone
City
State
Zip
Sex
Age on Race Day

Email Address

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Race Disclaimer: 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 agree to abide 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:  falls, contact with other participants, the effects of the weather, including heat and/or humidity, 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 Coast Episcopal School, Stablewood Subdivision, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participating in this event.  I grant permission to all of the foregoing to use any photographs, motion pictures, recording or any other record of this event for any legitimate purpose. 

Electronic Signature (Parent or Guardian if under 18)

Date: _______________

Make checks payable to:           CEPO

Mail to:

Race for Recovery

5065 Espy Avenue

Long Beach, MS  39560

(Checks are non-refundable)