Kootenai River Run Entry Form

Send completed form and check or money order to:

Kootenai River Run

c/o Jim Cadnum

3178 District Two Road

Bonners Ferry, ID 83805

Please make checks payable to Kootenai River Run

Last Name _______________________ First Name ____________   Gender ____ Age on race day _____

Address ________________________________ City __________________ State ____ Zip ___________

Phone Number ________________________  Email address ____________________________________

Race Entered  5k ______   10k _______

Where did you learn of our run? ___________________________________________________________

Shirt Size       S     M     L     XL     XXL       No Shirt   (please circle your choice)

Waiver:  I know that running a road race is a potentially hazardous activity.  I also know that, although police  protection will be provided, there will be traffic on the course route.  I assume the risk of running in traffic.  I also assume any and all other risks associated with running this event including, but not limited to, falls, contact with other participants, the effects of the weather, and the condition of the roads.  Knowing these facts, and in consideration of your accepting my entry, I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue, and waive, release, and discharge Kootenai River Run, race officials, volunteers, and all sponsors, including their agents, employees, assigns of anyone acting for or on their behalf, from all claims of liability for death, personal injury, or property damage of any kind arising out of my participation in this event.

Applications for minors will be accepted only with a parent’s or guardian’s signature.

Signature _____________________________________________  Date ___________________________

Signature of parent or guardian if runner is under 18 __________________________________________

Sponsored by Boulder Creek and Northwest Academies