Form

Boiling Pot 5k …the Run for the Rock
Full Name*

First Name
Last Name
Phone Number*

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Area Code
Phone Number
E-mail*
Age*
What will you be doing*
Shirt size*
Waiver*

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In consideration of my entry to this race, I hereby release and waive any and all claims for damage I may have against the Community Youth Center, Inc. the Village of Canajoharie and any and all sponsors and their representatives and any official or participant for any injuries I may suffer in conjunction with this race. I certify that I am in good physical condition and have trained for this race. I hereby grant all permission to any and all the foregoing to use any photographs, videotapes, motion
pictures, recordings or any other record of this event for any purpose
Refund Policy*

I understand there are no refunds given for the Boiling Pot 5k and Fun RunI agree to the terms to payment.
Boiling Pot 5k*

USD
Registration Fee
Should be Empty:

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