Name
Address
City, State Zipcode	,
Phone	(555-555-5555)
Email Address
Gender	Male Female
DOB:	/ /
Event Participation	<-- Select Event --> 5K Run Walk Walk With Dog
T-Shirt Size	<-- Select T-Shirt Size --> S M L XL
Dog Vest Size	<-- Select Dog Vest Size --> M L XL
Name of Shelter/Vest to go on vest
Microchipping Available offered by Sand Creek Animal Hostital
Would you like your dog microchipped?	Yes No
Emergency Contact
Emergency Phone	(555-555-5555)
Payment Method	Check PayPal <--Select Payment Method -->
If you will be walking with your dog, a few reminders: Dogs must be up to date on their rabies vaccination. You must be in control of your dogs at all times. No retractable leashes or leashes over 6 feet. Please pick up after your dog. Waiver ALL PARTICIPANTS IN RYLEY’S 5k RUN AND WALK AND RELATED EVENTS ("Event") ARE REQUIRED TO ASSUME ALL RISK OF PARTICIPATION IN THE EVENT BY ELECTRONICALLY SIGNING THIS GENERAL RELEASE AGREEMENT The undersigned athlete ("Athlete") on behalf of himself/herself and on behalf of Athlete’s personal representatives, assigns, heirs, executors, hereby fully and forever releases, waives, discharges and covenants not to sue the City of Albany, The Ryley’s Run, Delaware Valley Golden Retriever Rescue, State University of New York at Albany, and all municipal agencies whose property and/or personnel are used, and all other sponsoring or co-sponsoring companies or individuals related to the Event (collectively "Releases") from all liability to the Athlete and his/her personal representatives, assigns, heirs and executors, for all loss(es) or damage(S) and any and all claims or demands therefore, on account of injury to the Athlete or property or resulting in the death of the Athlete, whether caused by the active or passive negligence of all or any of the Releases or otherwise, in connection with the Athlete’s participation in the Event. The Athlete represents and warrants that he/she is in good physical condition and is able to safely participate in the Event. The Athlete is fully aware of the risks and hazards inherent in participating in the Event and hereby elects to voluntarily compete in the Event, knowing the risks associated with the event. The Athlete hereby assumes all risks of loss(es), damage(S), or injury(ies) that may be sustained by him/her while participating in the Event. The Athlete agrees to the use of his/her name and photograph in broadcasts, newspapers, brochures and other media without compensation. The Athlete acknowledges that the entry fee is non-refundable and non-transferable. In the event the Event is delayed or prevented by reason of fire, threatened or actual strike, labor difficulty, work stoppage, insurrection war, public disaster, flood, unavoidable casualty, acts of God or the elements (included without limitation, hurricanes, tornadoes, lightning, earthquakes), or any other cause beyond the control of Ryley’s Run, there shall be no refund of the entry fee or any other costs of the Athlete in connection with the Event. ATHLETE HAS READ THE FOREGOING AND INTENTIONALLY AND VOLUNTARILY ELECTRONICALLY SIGNS THIS RELEASE AND WAIVER OF LIABILITY AGREEMENT. IF ATHLETE IS UNDER AGE 18: The Parent/guardian certifies that my son/daughter has my permission to participate in the Event. The parent/guardian has read the forgoing RELEASE AND WAIVER OF LIABILITY AGREEMENT and by accepting the waiver intentionally and voluntarily agrees to its terms and conditions. The parent/guardian further certifies that my son/daughter is in good physical condition and is able to safely participate in the Event. I hereby authorize, medical treatment for him/her and grant access to my child’s medical records. Agree to Ryley's Run Waiver