Please complete the above fields, print the form, read and sign the waiver, then mail to the address below with a Check or Money Order.

Waiver: In consideration of your accepting my entry, I the undersigned, intending to be legally bound hereby, for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have against the Borough of Punxsutawney, Punxsutawney Road Runners/Walk Club, USA Track & Field, and any other sponsors and their representatives, successors and assigns, for any and all claims and liabilities of any kind arising out of my participation in this event, even though the liability may arise out of the negligence or carelessness on the part of the persons named in the waiver. I agree to abide by any decisions of a race official relative to my ability to safely run/walk . I assume all risks associated with running/walking, including but not limited to falls, contact with other participants, the effects of weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I attest and verify that I will participate in this event as a footrace entrant and that I am physically fit and sufficiently trained for the completion of the event.

Participant Signature ___________________________Date ______________
(NOTE - Participants under the age of 18 require the signature of parent or guardian)

 

PLEASE MAKE CHECKS PAYABLE TO:
Punxsutawney Road Runners Club

MAIL TO: Jim Bochert, 811 West Mahoning Street, Punxsutawney, PA 15767

NOTE: The entire form above and the waiver must be printed out legibly, completed, and mailed to the Punxsutawney Road Runners Club with the entry fee. If you are unable to make your browser print the above form legibly and completely, then e-mail us at Punxsutawney Road Runners or send a request to the above address or call (814) 938-6312 or cell at (814) 952-8397 for an entry form.