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Registration Form
(online registration is strongly encouraged)

Please Print

Last Name: _____________________________________________

First Name: _____________________________________________

Email: __________________________________________________

Street: __________________________________________________

City:_______________________ State:_________ Zip____________

(H) Phone:__________________ (C)Phone:____________________

Birthdate:_____________________ Gender: Male Female

T-Shirt Size (Circle one):  XXL   XL   L    M   S    Adult or Youth

Waiver and Release: I recognize that participation in this activity may involve certain hazards. I understand that I should not participate unless medically able. I assume risks associated with the involvement in this activity, including but not limited to falls, contact with participants, effects of weather and road conditions-these risks are known and appreciated by me. Having read this Waive and Release, and considering the acceptance of my application, I for myself and anyone entitled to act on my behalf, waive and release The Boys and Girls Clubs of Annapolis and Anne Arundel County, all race directors, committee members, volunteers, all sponsors and their representatives and successors, from any claim of liability arising from my involvement in this activity, I am physically fit and sufficiently trained to participate in this event.
Signature of Participant ______________________________ Date___________
(Parent or Guardian if under 18 years of age)
Please make checks payable and return form to:
121 S Villa St Annapolis, MD 21401