Additional Information
Name (please print) ______________________________________________________ Signature ______________________________________________________ Date ________________
Parent’s signature if under 18 ( ) ______________________________________________________ Date________________
Mail form with check to: David Tyson, 2620 Wynonah Drive, Auburn, PA 17922
Lake Wynonah Turkey Trot Run/Walk Entry Form (please print)
Name _____________________________________________________________________ Sex Male Female Birth Date ___________
Address____________________________________________________________________________________________________________________
Age on Race Day _____ Email __________________________________________ Shirt Size (circle one) Adult S M L XL Child S M L
Non-refundable Fee Enclosed $ ____________ Make Checks Payable to Lake Wynonah Athletic Group
Deliver form with payment no later than, Nov.1, 2012. After this date, register online at LWAG.LakeWynonah.com or on Race Day.
Please read and sign below.I understand that participating in a race is a potentially hazardous activity.I should not enter the Lake Wynonah Property Owners Association 5K run/walk at Lake Wynonah (“Event”) unless
I am medically able to do so and have been properly trained.I voluntarily assume all risks associated with the Event including, but not limited to:falls,contact with other persons,weather conditions,traffic hazards,road and
trail conditions,and any and all such other risks being known and unknown by me. Having read this waiver and intending to be legally bound hereby,I release the Keystone Wounded Warriors,Lake Wynonah
Homeowners Association,the Event sponsors (collectively “Sponsors”)and the officers,directors,agents,employees,assigns,successors and heirs of Keystone Wounded Warriors,Lake Wynonah Homeowners Association
and the Sponsors from any and all claims,demands,and causes of action in law and in equity of any kind arising from my participation in the Event and agree to defend the same against any action which may be made
on my behalf arising from my participation in the Event. I further grant permission to Keystone Wounded Warriors the right to use my likeness,in any media form for any purpose.Additionally,I agree to abide by any
decision of any Event official as to my ability to safely participate in the Event and I agree to abide by the Rules of Lake Wynonah during the Event.
RACERS WITHOUT SIGNED WAIVERS CANNOT PARTICIPATE
