Register For
Derby Day 5 miler & 5k

Shreveport, LA 71106

Registrant #1

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$25.00 + $2.50 SignUp Fee

$25.00 + $2.50 SignUp Fee


Waiver

In consideration of my being admitted to enter "Derby Day 5 miler", I, for myself, my heirs, and assigns, executors and administrators, do hereby forever release and discharge Sportspectrum, RRCA, Sportspectrum Race Management, D1 and all other sponsors or affiliates their employees and agents, of and from any and all claims or demands for damages, injuries, or liability, in any manner arising out of participation in this event.  I agree to indemnify and hold harmless the parties released above from any claims or demands for damages, for injuries or liability, in any way arising out of my participation in this event.  I certify that I have prepared myself for this race and that I am in adequate physical condition to complete the event I have entered.  I agree to follow all rules of this race and to permit myself be removed from the competition if in the opinion of Race Management that continuing would endanger my health. 

 

In the event of an illness, injury or medical emergency arising during the event I hereby authorize and give my consent to the Event Director to secure from any accredited hospital, clinic and/ or physician any treatment deemed necessary for my immediate care. I agree that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to medical transport, medications, treatment and hospitalization.

By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to the above release and waiver.

Further, I grant permission to all the foregoing to use my name, voice and images of myself in any photographs, motion pictures, results, publications or any other print, videographic or electronic recording of this event for legitimate purposes.




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