Last Name ________________________________________________________________

First Name______________________________________________ MI________________

Date of Birth __________________ Sex ________________ Age on Race Day __________

Address __________________________________________________________________

City _____________________________________ State ___________ Zip _____________

Email Address ______________________________________________________________

Release Indemnity and Assumption Agreement This Is A Legal Document. Do Not Sign It Unless You Fully Understand It. I know that running a road race is a potentially hazardous activity. I should not enter and run 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. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of the weather, including high heat-and/or humidity, rain/snow/ice, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry to participate in the City Run (hereinafter referred to as “Event”) on Saturday March 24, 2001 (or on such date as may be determined in the event of a postponement of the Event) in Louisville, Kentucky, I intending to be legally bound, do hereby for myself my heirs, my executors and administrators agree as follows: 1. I do waive and forever release any and all rights and claims far any liabilities of any kind arising out of my participation in the Event against all persons, entities and agencies involved with promoting the Event including Lithgow Industries, Incorporated or its subsidiaries (Rodes), the Metropolitan Park and Recreation Board, Jefferson County, Kentucky, the City of Louisville, P.A.R.C., their agents, successors, representatives, and assigns even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. 2. Further, I assume the risk of all bodily injuries, including death resulting therefrom, and personal injuries, to me and damage to and loss of my property, including loss of use thereof and any other indirect or consequential damages, resulting directly or indirectly, wholly or in part from my participation in the Event and while traveling to and from the Event; 3. Further, I hereby agree to indemnify and hold the entities specifically named in paragraph numbered 1 above harmless from and against any and all claims, liabilities, losses, damages, costs, expenses (including attorney’s fees), judgments, and penalties arising out of any of my acts or omissions to act; 4. Further, in the event the participant is a person under 18 years of age, the undersigned parent or legal guardian of the participant agrees to indemnify and hold harmless the entities named in paragraph numbered 1 above from and against all claims, liabilities, losses, damages, costs, expenses (including attorney’s Fees), judgments, and penalties arising out of the participant’s participation in the Event.

Participant's Signature _____________________________________ Date ___________

Parent's Signature (if under 18)_______________________________________________