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The event will take place Saturday, July 25, 2009
Please print and complete entire form / one person per entry form. We
sincerely thank you in advance for being a part of this life changing
event! All Participants receive a T-Shirt.
Begins at 8:00 a.m. Location Old River Baptist Church: 12948 F.M
1409 Dayton, TX 77535
5K
$25.00 (Enclose a check for
$25)
______13 - 19
______20 - 39
______40 - 59
______60-
3K
$15.00 (Enclose a check for $15)
______Toddlers with parent to 4yrs
______5-7
______6-12
Date:
_________________________________
Name______________________________________________________
Address____________________________________________________
City_______________________________________________________
State_____ Zip____________
Phone_________________________________
WAIVER: I know that participating in this walk/run is potentially
hazardous. I should not enter unless I am medically able and properly
trained. I also assume any and all risks associated with this event
including but not limited to falls, contact with other participants, the
effects of the weather, including high heat and/or humidity, and the
condition of the roads and traffic, all such risks being known and
appreciated by me.
Knowing these facts, and in consideration of your accepting my entry, I
hereby, for myself, my heirs, executors, administrators, or anyone else
who might claim on my behalf, covenant not to sue, and waive, release
and discharge the City of Old River-Winfree, Old River-Founder*s Day
Officials, Old River Baptist Church and/or any agents authorized by them
for any purpose related to the Old River-Winfree Founder*s Day and
Wounded Warrior Project events.
This release and waiver extends to all claims of every kind or nature,
whatsoever, foreseen or unforeseen, known or unknown.
Applications for minors are accepted only with a parent / guardian
signature.
____________________________________________________________
Signature of Participant/Date
____________________________________________________________
Parent / Guardian if Participant is under age 18/Date
For questions you may contact: 281-576-5356 or 281-576-6256. A Separate
Bank Account has been set up at Barbers Hill Bank in Mont Belvieu to
handle entry fees for the Run/Walk Event. When all is said and done, the
account will be zeroed out with a check to Wounded Warrior Project less
10% to the Pfc Wesley R. Riggs Memorial Scholarship Fund. All expenses
have been taken care of, so 100% of the donations, fees, etc. go to WWP
and the Memorial Scholarship Fund in its entirety. No Administrative
Fees AT ALL, no expenses AT ALL.
Please mail all forms and
fees to: Old River-Winfree
Founder’s Day Payable to Old
River-Winfree Founder*s Day
Wounded Warrior Project
P.O. Box 1169
Mont Belvieu, TX 77580 |