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1-Mile Walk/Run and 5K Trail Run

Sunday, September 21, 2014- 9:00am start time
All proceeds to benefit Camp Good Days and Special Times
Participant Registration Form
Included in your Harvest Dash registration fee, all participants and a guest or all immediate family members will receive
FREE admission to Critz Farms Fall Harvest Celebration for the remainder of the day.
All family members must report to Critz farms by 9:30 am for free admission to apply.
Event (circle one): 1-Mile Walk [$15] 1-Mile Run [$15] 5K Run [$20]
Acceptable forms of payment include cash and checks written out to Harvest Dash. September 15: $10 price increase.
Registrant Name: _________________________________I wish to make a monetary contribution of $ ___________
Address: _____________________________________________________________________________
City: ________________________________ State: ___________ Zip Code: ________________________
Email: _______________________________________Team Name (if applicable):____________________
Gender (circle one): M F Age on day of event: ________________
T-Shirt Size (circle one): Shirts guaranteed to all pre-registrations received by September 6. Post September 6 will be as available.
Youth Medium Adult Small Adult Medium Adult Large Adult XL
Emergency Contact: _______________________________ Phone: ______________________
I know that running and walking in a race is a potentially hazardous activity. I understand that the trail has rocks, ruts, mud,
sticks, exposed roots, uneven terrain and other obstacles. I should not enter and run or walk unless I am medically able and
properly trained. I agree to abide by the decision of any race official relative to my ability to safely complete the run or walk. I
hereby certify that I am in good health and I have trained to run or walk the distance of the race, which I am entering. I take
responsibility of all risks associated with walking or running this event including, but not limited to falls, contact with other
participants, the effects of the weather, including high heat and/or humidity and the condition of the course, all such risks being
known and appreciated by me. Having read this waiver, acknowledging these facts, and in consideration of you accepting my
entry, I for myself and everyone entitled to act on my behalf, waiver and release Critz Farms, Harvest Moon Cidery, Camp Good
Days and Special Times, the landowners, race organizers, volunteers, and all race sponsors from any claims or liabilities of any
kind arising out of my participation in this event. I grant my permission to use any photographs, motion pictures, recordings, or
any other record of this event for any legitimate purpose. I give my permission for medical release should I be involved in any
accident or health damaging situation or should I require a form of medical treatment. I understand that all my entry fees are
nonrefundable. I have read this waiver and certify my compliance and agree with its content with my signature.

Participant Signature: ______________________________________Date: _____________

Parent Signature (If under 18 years old): ___________________________________________
Return this form and payment by September 21 in person to:
Harvest Dash at Critz Farms, 3232 Rippleton Road, Cazenovia, NY 13035