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Currently viewing: Todd's Trot » Entry Form
Complete the following, print & return with fee to Jean Parsons, 16 Stevens Way, Durham, NH 03824.
Pre-entry free of $22

Last name:
First name:
Street address:
City:
State:
Zip:
Phone:
Email:
Gender:
Age on race day:

I understand what the aforementioned race involves & believe that I am in proper physical condition to participate. In consideration of being permitted to participate in the aforementioned race, I hereby agree to assume all of the risks & responsibilities arising out of my participation, & do for myself, my heirs & personal representatives hereby hold harmless indemnify, release & forever discharge the Granite State Race Services & the Town of Durham, Friends of Oyster River Track & any & all employees, officers, representatives, volunteers or agents of these organizations from & against any & all claims, demands & actions or causes of action, on account of property damage, physical damage, physical injury or death which occur during the period of my participation. I have read & fully understand this release statement. I also understand that NO REFUNDS will be given.


Signature of entrant


Date

 


If under 18, parent of guardian (Signature required)