East End Sizzler 5K

East End Sizzler 5K

East End Sizzler 5K October 1, 2016 • 8:00 a.m. East Union Missionary Baptist Church in East End Community (Saline County) Street Address: 20422 Nort...

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East End Sizzler 5K October 1, 2016 • 8:00 a.m.

East Union Missionary Baptist Church in East End Community (Saline County) Street Address: 20422 North Springlake Road • Hensley, Arkansas 72065 Proceeds to benefit the Little Rock South Lions Club. For more information call 501-888-3522.

Participant Information Last Name

First Name

Home Address

City

Date of Birth (MM/DD/YY)

Age on Date of Race

Daytime Phone

E-mail Address

T-Shirt Size (circle one)

State Gender (M/F)

Adult size:

S

M

L

XL

Child size:

YS

YM

YL

YXL

XXL

XXXL

Special Group Rate:

Entry Fee Included $25 - early registration (received by Sept. 4) $30 - day of race or received past Sept. 4

Zip

$20 each - 3 or more entries received together with payment by Sept. 4

Day of race registration will begin at 7:00 a.m. and end promptly at 7:45 a.m.

Make checks payable to Little Rock South Lions Club and mail to: 3022 E. Woodson Lateral Road, Hensley, AR 72065. All pre-registered participants will receive a t-shirt. Other participants will receive a t-shirt while supplies last. Trophies will be given to the overall male and female winners. Awards will also be given to 1st-3rd place finishers, male and female, in the following age divisions: 13 & under; 14-19; 20-29; 3039; 40-49; 50-59; 60-69; 70+. WAIVER AND RELEASE OF CLAIMS: I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in this event. I am a voluntary participant in this event, and in good physical condition. I know that this event is a potentially hazardous activity and I hereby assume full and complete responsibility for any injury or accident which may occur during my participation in this event or while on the premises of this event, and I hereby release and hold harmless and covenant not to file suit against Little Rock South Lions Club, its local affiliates and any affiliated individuals, the East End Sizzler 5K, ArkansasRunner.com, any race sponsors and their agents and employees, and all other persons or entities associated with this event (the “Releasees”) from any loss, liability or claims I may have arising out of my participation in this event, including personal injury or damage suffered by me or others, whether same be caused by falls, contact with participants, conditions of the course, negligence of the Releasees or otherwise. If I do not follow all the rules of this event, I understand that I may be removed from the competition. PHOTOGRAPHIC RELEASE: I give my full consent and permission to Little Rock South Lions Club, its local affiliates and races, their sponsors and corporate sponsors, their successors, licensees, and assigns the irrevocable right to use, for any purpose whatsoever and without compensation, any photographs, videotapes, audiotapes, or other recordings of me that are made during the course of this event (“the Event”). The Photographic Release and Waiver and Release of Claims (collectively, the “Release”) shall be construed under the laws of the state in which the Event is held. I understand that I have given up substantial rights by signing this Release, and have signed it freely and voluntarily without any inducement, assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of liability to the greatest extent allowed by law.

Participant’s Signature (or Parent/Guardian if participant is under 18)

Date