Tom McCoy Family Fun Run Series 2008
Waiver of Liability and Assumption of Risk

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Complete the form and bring with you to the first fun run.

In consideration of accepting my entry, I, the undersigned, intending to be legally bound, hereby waive and release any and all rights and claims for losses and damages that I may have against the Westerly Track & Athletic Club, Inc. and its members; the Town of Westerly, its agents and administrators and representatives for any and all injuries that I may suffer from participating in the Westerly Track & Athletic Club Fun Run Series 2008.

Any participant under 18 years of age must have a parent's written consent to participate.

This waiver of liability and assumption of the risk is based upon Rhode Island Statute 7-6-9 entitled Exemption from Liability.

I certify that I have read and understand the Exemption from Liability.

Name: ___________________________________ Age: _______

Address: _______________________________________________

City: __________________________ State: _______ Zip:__________

Signature: ___________________________________________________
(Parent if participant under age 18)

Other family members:

Name: ___________________________________ Age: _______

Name: ___________________________________ Age: _______

Name: ___________________________________ Age: _______