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Sunday July 15, 2012 10:00 AM
Horse Hill Nature Preserve
Merrimack, New Hampshire
The Broken Boulder 6K Trail race is a fast and fun
romp through beautiful Horse Hill Nature Preserve.
Pre-Entry Fee: $20.00 --- Post Entry Fee: $25.00
Make
check payable to: 3C Race Productions,
and
mail
to: Broken Boulder Dash 6K, 160 Amherst Road, Merrimack, NH
03054
Name
:_
_____________________________________
Circle Gender:
M
F Age:______
Circle T-Shirt Size: S M L XL
Address:_______________________________________
Phone:______________________
City
:_
___________________State:___ Zip Code:______
Email:________________________
Club:
_______________________________________________
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I know that running is a potentially hazardous activity. I should
not enter or run/walk this event 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/walk. I assume
all risks associated with running in this race including, but
not limited to, falls, contact with other participants, the effects
of weather, including high heat and/or humidity, the conditions
of the road and traffic on the course, all such risks being known
and appreciated by me. Having read this waiver and knowing these
facts, and in consideration of your acceptance of my application,
I, for myself and anyone entitled to act on my behalf, waive and
release the the town of Merrimack, NH; 3C Race Productions LLC; and
all sponsors, their representatives and successors from 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.
All fees are nonrefundable.
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____________________________________ ________ __________________________________ Signature
Date Parent's Signature if under
18 |
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