Town of Randolph

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Per Person:

$15.00

Quantity:

Item Subtotal:

$0.00

Name of Participant	[1]
Age of Participant	[1]
T-Shirt Size (Shirts may run small, please order generous size)		[1]
Name of Participant	[2]
Age of Participant	[2]
T-Shirt Size (Shirts may run small, please order generous size)		[2]
Name of Participant	[3]
Age of Participant	[3]
T-Shirt Size (Shirts may run small, please order generous size)		[3]
Name of Participant	[4]
Age of Participant	[4]
T-Shirt Size (Shirts may run small, please order generous size)		[4]
Name of Participant	[5]
Age of Participant	[5]
T-Shirt Size (Shirts may run small, please order generous size)		[5]
Name of Participant	[6]
Age of Participant	[6]
T-Shirt Size (Shirts may run small, please order generous size)		[6]
Name of Participant	[7]
Age of Participant	[7]
T-Shirt Size (Shirts may run small, please order generous size)		[7]
Name of Participant	[8]
Age of Participant	[8]
T-Shirt Size (Shirts may run small, please order generous size)		[8]
Name of Participant	[9]
Age of Participant	[9]
T-Shirt Size (Shirts may run small, please order generous size)		[9]
Name of Participant	[10]
Age of Participant	[10]
T-Shirt Size (Shirts may run small, please order generous size)		[10]

(Includes Race, T-Shirt & Breakfast)

If you are interested in breakfast only - please indicate below

Per Plate:

$5.00

Quantity:

Item Subtotal:

$0.00

Per Family:

$25.00

Quantity:

Item Subtotal:

$0.00

Total:

$0.00

ON LINE REGISTRATION, JUNE 15-JULY 1, 2021

You can register the day of the race for:
$5.00 (Individual, includes breakfast)
$25.00 (Family, includes breakfast)
This includes the race and breakfast only, no T-shirts will be available after July 1 registrations

JUST SHOW UP RACE DAY AND RUN THE RACE FOR FREE

Questions: Call Heidi Weston at 435-881-7789

I herewith agree and promise to Indemnify and hold Town, its officers, agents, officials and employees, and volunteers harmless and release them for and from any liability, costs or expenses arising from any action, causes of action, claims for relief, demands, damages, expenses costs, fees or compensation whether or not said action, causes of action claims for relief, demands, damages, costs, fees, expenses and/or compensation are known or unknown, are in law or equity and without limitation, all claims or relief which can be set forth through a complaint or otherwise that may arise out of my child's use of city property, facilities or equipment, participation in the above described program or the acts or omissions, negligent or otherwise of Child, Town and/or their respective offices, agents, officials, members, employees, and volunteers, or any person or persons.I acknowledge that I have been advised to consult legal counsel and have had the opportunity to consult with legal counsel prior to entering into the Indemnification, Hold Harmless, Release of Liability Agreement.

I understand and agree that by signing this Indemnification, Hold Harmless, Release of Liability Agreement, that I relinquish all rights or claims to adjudication or recourse to which I may be entitled in relation to any damages or injures that may arise out of the above described activities.

I Agree

By clicking this box you acknowledge and agree to the statements above. A signed indemnification form will not be necessary.

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