Please Enter me in the Kurtz/Dwyer Memorial 4 miler. I agree to assume
all responsibility for all risk of damage or injury to ma as a participant in this event.
In consideration of being accepted, I hereby, for myself, for my heirs, executors and
administrators, release and discharge any and all individual organizations associated with
the race from all claims, damages, rights of actions, present or future, whether the same
be known, anticipated, or unanticipated, resulting from to or arising of, or in incident
to, my participation in this event. I hereby certify that I will not participate in this
race/walk: unless I am physically fit and sufficiently trained for competition in the race
/walk.
Signature:
Parent of Guardian (if under 18):
Make checks payable To:
Kurtz/Dwyer Memorial run 306 Circle Dr. W. Spfld. Ma. 01089
All Proceeds To Benefit High School Athletic Scholarships
