Cider 5 Registration Form – Race Date: October 12, 2019 9:00 AM (Use drop-down above/right to print)
Race Location: 626 County Route 22, Middletown, NY 10940
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First Name___________________________ Last Name______________________________
Address__________________________________________State_______Zip_____________
Phone _____________________________Email____________________________________
Age on Race Day________ Birthdate_____/_____/______ Male_______Female_______
T Shirt Size ( circle one ) S M L XL 5M-Run_____ 2M-Walk_____
Make Checks Payable to: Knights of Columbus
I/We, the undersigned, intending to be legally bound, hereby, for myself, my heirs, and administrator waive and release any and all claims for damages I may have against the Knights of Columbus, the race organizers, and all sponsors, Town of Wawayanda, Town of Minisink, volunteers, and vendors from all liability arising from illness, injuries and damages I may suffer as a result of my participation in this event. I do hereby certify that I am physically fit and sufficiently trained for this event.
Date________________ Signature of Participant_______________________________