Beyer High School 1717 Sylvan Ave. Modesto, CA 95355
Registration Form
Full Name: _____________________________________________________
Gender: Male / Female (circle one) Age: (on race day) ______ DOB______________
Mailing Address: ________________________________________________
City: ________________________________ State: _______ Zip: __________________
Phone: (____) ________________ Email: _____________________________________
Shirt Size Unisex: (circle one) S M L XL 2XL
Event Website: Register at Active.com or beyerathleticboosters.com
EVENT INFORMATION: The Beyer High Athletic Booster Club is hosting the 2nd Annual Patriot
Revolutionary Run on Saturday, April 18, 2015. Registration begins @7-7:45am and race starts
@ 8:30am. The proceeds from this event will help support the athletic teams at Beyer High
School and help fund athletic scholarships. The race will start and end in the Faculty parking lot
on the SE corner of Beyer and take you through the beautiful neighborhoods behind the school.
Parking will be in the main parking lot by the gym
Race Fee:
On line registration at Active.com with credit card or pay pal
Pre-registration: $25 (age 18 & over)
$15 (age 5-17)
Day of race:
$30 (age 18 & over)
$20 (age 5-17)
T-shirts: Each pre-registered participant will receive a commemorative t-shirt. T-shirts are not
guaranteed for those who register day of the race.
Mail registration to: Attention: Beyer Boosters/ Patriot Revolutionary Run,
1717 Sylvan Ave, Modesto, CA 95355
Timing: Self timing with running clock at the finish line
Event Disclaimer: Please review the following waiver and disclaimer. By adding your signature, you accept this Waiver and Disclaimer. Waiver and Release: By
participating in this event, I do so at my own risk. I assume all risk of injury, illness, damage or loss to me or my property that might result, including without limitation, any loss
or theft of personal property. I consent to medical treatment in the event of injury, accident, and/or illness during the event. I agree on behalf of myself (and my personal
representatives, heirs, executors, administrators, agents, and assigns) to release and discharge the organizers of this event, its principals, its officers & directors, its employees,
all sponsors and their representatives and employees from any and all claims or causes of action (known or unknown) arising out of their negligence. I acknowledge that I have
carefully read this “Waiver and Release’ and fully understand that is a release of liability. By my signing below, I am waiving any right that I may have to bring legal action to
assert a claim against any and all Event sponsors for their negligence. I hereby grant full permission to use any of the foregoing to use my name and likeness in any broadcast,
telecast, video, or print media reporting or advertising of the Event without compensation.
I agree
Sign here________________________________________________________________