7/31/2019 Kmxt Run Waiver

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RACE RELEASE AND WAIVER FORMIn consideration of my (or if the participant is a minor, the minors) entry and/or participation inthe KMXT RUN THE ROCK RACE and associated events, I do hereby release, discharge,hold harmless, indemnify, acquit, and promise not to sue Kodiak Public BroadcastingCorporation (KPBC), KMXT Public Radio, its agents, employees, race officials, sponsors, andvolunteers from any and all claims of damage, causes of action, suit, costs, charges, claims,demands and liabilities of whatever kind, name, or nature in any manner arising out of my (or ifI am signing as parent or legal guardian of a minor, the minors) participation or involvement insaid race and associated events. This release extends to all claims of every kind or nature

whatsoever, foreseen or unforeseen, known or unknown. This release is intended to cover allnon-fatal or fatal injuries and illnesses of any kind or nature which may be sustained or suffered from any cause whatsoeverconnected or arising out of the participation in, or involvement with, the KMXT Run the Rock Race and associated events.

I, the undersigned, know that the KMXT RUN THE ROCK RACE MARATHON, HALF-MARATHON AND 5-KILOMETER RACES are events which carry the risk of personal injury. I know that there are natural and man-madeobstacles and hazards, surfaces, and environmental conditions and risks, which in combination with my actions orothers actions, can cause severe or even fatal injury. I also know that there will be traffic on the course route, andassume the risk of running in traffic. I agree that I, as either a participant or legal guardian of a participant who is aminor, must take an active role in understanding and accepting these risks, conditions and hazards, and I attest andverify I have full knowledge of the risks involved in such events.

I also agree that I, and not the race officials, volunteers, Kodiak Public Broadcasting Corporation, KMXT, sponsors orothers associated with the event, am responsible for my (or if I am signing as the legal guardian of a minor, theminors safety) while I (or the minor) participate or train for these events.

Further, I agree that if the race is canceled or postponed, I am responsible for any costs I have incurred to attend therace, including travel expenses.

I hereby grant full permission for KMXT or its designated agents to use any photographs, videotapes, recordings, orany other record of these events for any purpose without compensation.

Participants Name: _____________________________________________ Date: __________________

Address ______________________________________________________ Phone ______________________

Participants Signature: ______________________________________________(Parent must sign if Participant is under 18 years of age)

MARATHON| HALF-MARATHON| 10-KILOMETER| 5-KILOMETER

T-SHIRT SIZE: SMALL| MEDIUM| LARGE| X-LARGE| XX-LARGE

_____________________________________________________________________________________________

FEES FOR RUNNING AND/OR WALKING EVENTS:

(Early registration through September 18, 2010.)

EARLY LATE

MARATHON: $40 $45

HALF-MARATHON: $25 $30

10-KILOMETER $15 $18

5-KILOMETER: $15 $18

5-K AGE 12 & UNDER: $8 $10

5-K FAMILY $25 $30

Group Rate (up to 5 people) $60 only available for pre-registration

TOTAL FEES INCLUDED: $_________ _________

REGISTER ONLINE at www.KMXT.org.

Or PLEASE MAKE CHECKS PAYABLE TO KMXT.

REGISTRATION CAN BE MAILED TO: KMXT, 620 EGAN WAY, KODIAK, AK 99615

Or FAXED TO: (907) 486-2733