Medicine Run / Walk & Health Fair

Registration Form
   
   
Name:                 Age on April 19th, 2008:                
   
Phone:                 Sex:                
   
Street Address:                
   
City:                               State:                                 Zip:                
   
Events: (check all that apply)
5K Run / Walk
1 Mile Walk
Obstacle Course (12 years or younger)		  
   
Adult t-shirt size:
 S
M
L
XL
XXL ($1 extra)		 Child t-shirt size:
S
M
L
XL
   
Wheelchair Participants: Will Assistance be needed?
   
Waiver and Release:

I understand that I waive all rights and claims for damages or injuries that I or my assigns may have against OU-COM student organizations, community service program and affiliated programs, health fair sponsors, Ohio University, the City of Athens or their representatives, assigns or agents. I also certify that I have adequately trained for this event and am not suffering from any injury or other condition, which might be seriously aggravated by my participation in this event.
   
Signature: (Will Sign Upon Check-In on Day of Race)  

Today's Date: