Fightin Cancer 5K

Name (First and Last) ____________________________________

Age_______

Email __________________________________________
Address________________________________________
Sex: M F

Phone_______________

T-Shirt Size: S M L XL XXL

Make Checks and/or donation Payable to: Danielle Hawkins
1020 N Oak St.
Clovis NM, 88101

RELEASE OF LIABILITY
I,_________________________(print name), acknowledge that my participation in the
5k Fun Run and Walk involves a risk of injury, including bodily injury, and assume the
risk for same. On my own behalf and on behalf of my heirs and legal representatives
and to the fullest extent permitted by law, I hereby release and discharge Danielle
Hawkins and anyone family members, friends, or anyone else involved in executing this
event of and from any and all liability for injury, death, or damages and/or any other
claims, demands, losses or damages, incurred by me in connection with any aspect of
the 5k run and walk.
**Sign and date below

X
Signature of Participant

X
Signature of Parent
If particiaptant is not 18