Covenant Kids Run March 28, 2015 2015 Registration Form FILL OUT COMPLETELY • PRINT CLEARLY • ONE ENTRANT PER FORM ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Last Name ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Birthdate mm/dd/yy ■ ■ /■ ■ /■ ■ Age on Race Day ■ ■ Gender (M) ■ (F) ■ Street Address ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ City ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ County ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ State ■ ■ Zip ■ ■ ■ ■ ■ School ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ First Name Grade (Circle one) K 1 2 3 4 5 6 7 8 Shirt Size (Circle one) YS YM YL YXL Adult S Parents and guardians may run with their child if they wish. For safety reasons, adults will be required to wear a bib/runners number to accompany the child on the course. Every child who enters the event will be given two bibs with the same number—one for the child and one for the accompanying adult. Each child receives ONE complimentary bib for an accompanying adult or guardian. If an additional adult wishes to participate with the child, please complete the “Additional Entry - $5 Fee” section of the registration form. No one is allowed on the course without a bib. For lost parent/child reasons, the child and adult bibs will both contain the child’s information. NOTE: Additional Entry - $5 Fee” does NOT include a t-shirt for the accompanying adult. 10/1/14 - 2/15/15: $15 2/16/15 - 3/15/15: $20 At Expo/Day of Race: $25 PARENT or GUARDIAN ENTRY / EMERGENCY CONTACT Additional Entry: $5 ■■■■■■■■■■■■ Last Name ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Phone ■ ■ ■ - ■ ■ ■ - ■ ■ ■ ■ Email ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ . ■ ■ ■ First Name ADDITIONAL ENTRY - $5 FEE ■■■■■■■■■■■■ Last Name ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ First Name Adult M PAYMENT INFORMATION Entry Fee TOTAL FEE: ■ ■ ■ Mail completed entry form and check payable to Knoxville Marathon PO Box 53442 Knoxville, TN 37950 ENTRY FEE IS NON-REFUNDABLE __________________________ For office use only Rec’d ■ Check #■ By indicating your acceptance, you understand, agree, warrant and covenant as follows: In consideration of your accepting this entry, I, the undersigned, intending to be legally bound, hereby, for myself, my family, my heirs, executers, and administrators, forever waive, release & discharge any and all rights & claims for damages & causes of suit or action known or unknown, that may have against the Knoxville Marathon, The Knoxville Track Club, Covenant Health, The City of Knoxville, Road Runners Club of America, Altman Consulting, and all other political entities, all independent contractors & construction firms working on or near the course, all Knoxville Marathon Race Committee persons, Officials & Volunteers, & all sponsors of the Marathon, & the related Marathon Events & their officers, directors, employees, agents & representatives, successors, & assigns, for any and all injuries that may be suffered by me in this event. I attest that I am physically fit, am aware of the dangers & precautions that must be taken when running in warm or cold conditions, & have sufficiently trained for the completion of this event. I also agree to abide by any decision of an appointed medical official relative to my ability to safely continue or complete the run. I further assume and will pay my own medical & emergency expenses in the event of an accident, illness or other incapacity regardless of whether I have authorized such expenses. Further, I hereby grant full permission to the Knoxville Marathon and/or agents hereby authorized by them, to use any photographs, videotapes, motion pictures, recording, or any other record of this event for any legitimate purpose at any time. I further understand that there are no entry refunds, exchanges, transfers or rollovers, and that the event may be cancelled due to severe weather conditions, natural disasters, or threats to local and national security including suspected terrorist activity. I understand if I use a MP3 player, IPOD, headset, cell phone or other electronic device while participating in the event, I will do so in a reasonable way using common sense and awareness of those around me. I have read this waiver carefully & understand it. ___________________________________ Signature of Parent or Guardian (Required) __________________ Date 8300-9510 PARENT/GUARDIAN MUST SIGN BELOW TO COMPLETE THIS ENTRY FORM