7/31/2019 Jan Peek 2012 Application
1/1
and
Present the 2012:
JAN PEEK 10kmSponsored by: D. Bertoline & Sons Inc.
SATURDAY, AUGUST 4, 2012, 7:45am
Scored by: Taconic Road Runners ClubRace Director: John Hallinan
914-7392268
T-SHIRTS TO FIRST 100 PARTICIPANTS
FEE: $15 pre (postmarked by 7/31/12) $18 day of race
Check in: Kiley Youth Center, Spring St. & Main St.,
beginning at 7:00am
Make Checks payable to: PEEKSKILL CELEBRATION
Mail Entries to: Peekskill Celebration1008 Park St.Peekskill NY
10566
Post Race Festivities and Awards at the Division St.
Gazebofollowing the race.
Checkwww.peekskillcelebration.com for a complete schedule of
weekend events.
--------------------------------------------------------------------------------------------------------------------------Jan
Peek 10km Application
Name (print
clearly)______________________________________________ Telephone:
________________________
Address ____________________________________________________
email:__________________________Street City State Zip Code
Age on Race Day___________ Male_____ Female_____I know that
running a road race is a potentially hazardous activity. I should
not enter and run/walk unless I am medically able and properly
trained. I agree to abide by any decision of the race official
relative to my ability to safely complete the run. I assume all
risks associated
with running this event including, but not limited to falls,
contact with other participants, the effects of the weather,
traffic and the conditions
of the road, all such risks being known and appreciated by me.
Having read the waiver and knowing these effects and in
consideration of your
acceptance of this entry, I, for myself and for anyone entitled
to act on my behalf, waive and release the City of Peekskill,
Peekskill
Celebration, Town of Cortlandt, Entergy Nuclear Northeast,
Taconic Road Runners Club, and all sponsors, their representatives
and
successors from all claims of liabilities of any kind arising
out of my participation in this event, even though the liability
may arise out of
negligence or carelessness on the persons named in the waiver. I
grant permission to all the foregoing to use any photograph, motion
picture,
recording, or any other record of this event for any legitimate
purpose. I understand that bicycles, skateboards, roller
skates/blades, animals,
and radio headsets are not allowed in the race, and I will abide
by this rule.
Signature ___________________________________ (parents signature
if under 18) Date____________
Mail to:Peekskill Celebration, 1008 Park St., Peekskill NY
10566
http://www.peekskillcelebration.com/http://www.peekskillcelebration.com/
