www.houseofrefugewc.org

Please print legibly and complete the entire entry form. More than one entry may be mailed together with the appropriate fees. Please make all checks and money orders payable to House of Refuge Worship Center.

The race starts at 9:00 am.

Race Waiver: I, individually, (as a parent or guardian of the named minor) for and in consideration of the acceptance of this entry in the event mentioned above, do hereby release, remise, waive, and forever discharge House of Refuge Worship Center, the City of Newport News and all other supporting groups of this said racing event, together with all their officers, agents, officials and employees, from all liability, claims, demands, actions, causes of action whatsoever arising out of, or relating to any injury, illness, loss, or damage, including death, relating to participation in the event mentioned above. I further state I am in proper physical condition to participate in this event. In addition, I agree that my participation in this event requires that I will not participate with rollerblades, skateboards, or anything that the race director deems dangerous to myself or other participants and that the race director may remove me from this event for a violation of said policy. I further grant permission to this race and the organization conducting the race and/or agents authorized by them to use any photographs, videotapes, motion pictures, recordings, and any other record of this event for any purpose. I also agree that all entry fees are non-refundable and that this entry is non-transferable. Thank you for participating and helping us make history!