Name:
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phone:	age:
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Recreational Division:(not timed) "I will walk/Run for fun." "I'm bringing my dog!" "I am signing up for the diaper derby."

Competitive Division:(timed) Bib pick-up all week before Old Bill's at the Community Foundation office. 5K Women 5K Men 10K Women 10K Men 5K Youth Male (7-14) 5K Youth Female (7-14)

All event participants must sign this waiver of liability. If you are the parent/guardian of children entering the event, please provide those names on the waiver below.

I, acting for myself and (if applicable) as the legal parent or guardian of hereby release sponsors and organizers of Old Bill's Fun Run for Charities from any claims for damages or injuries suffered as a result of my and/or my child's/children's participation in this event and waive any claim that I or my child/children might have against the sponsors and organizers for damages arising out of, or in any way relating to my or my child's/children's participation in this event. I hereby consent to and permit and accept the responsibility for emergency medical treatment in the event of injury or illness suffered by myself and/or my child/children. I grant the Community Foundation of Jackson Hole the right to use and incorporate, in whole or part, photographs or videotape taken of myself and/or my children for use in Community Foundation materials and waive any right to royalties or other compensation related to use of those photographs or videos.

By submitting your registration, you agree to the terms of this waiver.