--> ENTRY FORM July 30, 2011 - Barre Heritage Festival 5K  
    Trail Race at Millstone <--

   Name _____________________________________________


   Age on Race Day: ______   Gender:    M      F  

   Mailing Address __________________________________

   City _____________________________   State _______

   Zip Code ________________________

I know that running a road race is a potentially  
hazardous activity. I should not enter and run unless 
I am medically able and properly trained. I agree to   
abide by any decision of a race official relative to    
my ability to safely complete the run. I assume all 
risks associated with running in this event including,  
but not limited to, falls, contact with other part-
icipants, the effects of the weather, including high 
heat and/or humidity, traffic and the conditions of 
the road, all such risks being known and appreciated 
by me. Having read this waiver and knowing these 
facts and in consideration of your accepting my 
entry, I, for myself and anyone entitled to act on 
my behalf, release and hold harmless the Central 
Vermont Runners club and all sponsors, their represen-  
tatives and successors from all claims and liabilities  
of any kind arising out of my participation in this 
event even though that liability may arise out of 
negligence or carelessness on the part of the 
persons named in this waiver.


Signature _____________________     Date ___________

____________________________________________________
Signature of parent or guardian if participant
under 18 years of age