Hit The Bricks Registration Form
April 14, 2007 8:00 AM
Payment
Information:
Make
all checks payable to “Hit The Bricks”
and mail to:
Fort
Worth Running Company
5800
Camp Bowie, Fort Worth, TX 76107
Phone
817-731-1760
Registration Fee (Check One) : Single $18 ($20 after 4/7) ___
Group of 5 or
more ($15 each) ___
FWISD Team Rate is $10.00 per student ($10 each)___
Race Day
($25)___
Check No. ________________ Amount ___________________
_________________________________________________________________
Personal Information:
Last Name _____________________ First Name
____________________
Address
_______________________ Phone ________________________
City
__________________________ St ____
Zip ___________________
Age ___
Date of birth ___ / ___ / ___
Sex (Check) : Male___Female___
Event(check):
5K___
T-Shirt Size (check) : Youth___ S___
M___ L___ XL___
XXL (add $2)___
Family/Team Name (For Groups) :________________
Packet Pickup Location (Check): Fort Worth Running Company____ Race Site on April 14th ____
Packets are available Thu-Fri, April 12, 13th at
Fort Worth Running Company
Packets not picked up by Friday afternoon, April 13th at 6 PM will be taken to the Race Site
Waiver: I know that running or walking a road race is a potentially
dangerous activity. I should not enter
and run or walk 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 walk or run. I assume all risks associated with running
or walking in this event including, but not limited to: falls, contact with
other participants, the effects of the weather, including high heat and/or
humidity, traffic and 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 of my behalf, waive and release
The City of Fort Worth, Hit The Bricks
5K Run/Walk and all sponsors, their representatives and successors and all
claims or 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.
I grant permission to all the foregoing to use any photographs, motion
pictures, recordings, or any other record of this event for any legitimate
purpose. Race will be held regardless
of the weather conditions. Registration
is final. No refunds.
Signature (Parent or guardian if under 18) ___________________________________________