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Arizona Road Racers Rio Vista Luck Of The Draw Run Kids Form (17 and under) Last Name: First Name: Email: Address: City: State: Zip Code: Phone: Chip ID (if you own one): Gender: Female Male Age on race day: Date-of-birth (mm/dd/yyyy): / / Event: 8K Run 8K Walk 2 Mile Fun Run/Walk Name of Parent/Guardian: By clicking this button, I understand that participation in the 2010 Arizona Road Racers Rio Vista Luck of the Draw involves running in extremely hot and humid conditions that make this a grueling race. I understand there is risk of damage, illness or death due to the heat and humidity. In consideration of the above, I fully assume all risks of damage, illness, injury or death I/(my child) may suffer as a result of participation in the race (including travel and any race related activity) or as a result of the negligence of any of the Releasees identified below. I voluntarily waive any rights, claims, and causes of action I have or may have against the following Releasees and their agents, representatives, successors and assigns: The Arizona Road Racers, USA Track & Field, Maricopa County, the City of Peoria Community Services Department and any race officials, volunteers, sponsors, or anyone associated with this event. I understand my right to bargain for different waiver of liability terms and waive that right. The foregoing release is binding on me personally, as well as upon my heirs, executors, administrators, personal representatives, successors and interested persons who might make a claim on my behalf. I further state that I am in proper physical condition to participate in this event. I will additionally permit the free use of my/(my child's) name and/or picture in a broadcast, telecast, newspaper, on a website or account of this event. IF ATHLETE IS UNDER 18: This is to certify that my child has my permission to compete in the 2010 Arizona Road Racers Rio Vista Luck of the Draw, is in good physical condition and that race officials have permission to authorize emergency treatment if necessary. I warrant that all statements made herein are true and correct and understand that Releasees have relied on them in allowing me/(my child) to participate. I UNDERSTAND I AM REQUIRED TO RETURN THE CHAMPION CHIP TIMING DEVICE ISSUED TO ME OR I WILL BE LIABLE FOR A $35 REPLACEMENT FEE. ® copyright 2010 | Arizona Road Racers | all rights reserved