14th Annual Liberty Bank Clinton Bluefish 5K

 

Saturday August 20, 2011

 

Jared Elliot Middle School, 59 Fairy Dell Road, Clinton, CT

 

REGISTRATION STARTS AT 7:00 A.M.

 

Sponsored by	Divisions
	(Male and Female)	Snappers        UP to 8 Pre-Teen        9 to 12 Teen             13 - 19 Open             20 - 29	Sub-Masters        30-39 Masters              40-49 Grand Masters     50-59 Silver                 60-69 Golden               70-79  Platinum               80+
Registration PRE-Register (by 8/19/11) $16 Day of Race - $20   Make Checks Payable to: Clinton Chamber of Commerce		T-Shirts for the first 350 Pre Registrations LAST NAME                 FIRST NAME ______________________________________   MAILING ADDRESS   ______________________________________   TOWN                         CT     ZIP CODE   ______________________________________   AGE    MALE FEMALE   PHONE NUMBER ______________________(___)____________
MAIL TO: Chamber of Commerce 50 East Main Street PO BOX 334 Clinton, CT 06413
		Email Address: ____________________	_____________________

 

In consideration of your acceptance of this entry, I, the undersigned entrant, intending to be legally

bound hereby for myself, my heirs, my executors and administrators, waive and release any and all

rights and claims for damages I may have against the Town of Clinton, the Clinton Chamber Of

Commerce, Shoreline Community Women, Inc. or any other sponsors or supporters, or any of their agents,

successors or assigns for any and all accidents, illnesses or injuries suffered or sustained by me either during

or as a results of the race. I attest and verify that I am in sufficiently good physical health to participate in the event; 

that I am sufficiently trained for this event and its completion; and that my physical health has been verified

by a licensed medical doctor. Please, no dogs in the race.

 

_____________________________________        _____________

Runner's Signature                      Date

 

(Parent or Guardian must sign if the runner is under 18)

NOTE: Parent/Guardian agrees to accompany any entrant under 15 years of age to said event.