57th Annual Charlton Old Home Day 5-Mile Road Race

Please enter me in the Charlton Old Home Day Road Race. I agree to assume all responsibility for all risk of damage or injury to me as a participant in this event. In consideration of being accepted as an entrant in the Charlton Old Home Day Road Race, I hereby, for myself, my heirs, executors and administrators, release and discharge all organizations and individuals associated with the race from all claims, damages, rights of action, present or future, whether the same be known, anticipated, or unanticipated, resulting from or arising out of, or in incident to, my participation in this event. I hereby certify that I will not participate in the race unless I am physically fit and sufficiently trained for competition in the race. I also grant permission for the use of my name and/or picture in any broadcast, photograph or other account of this race. I understand that bicycles, skateboards, baby joggers or strollers, roller skates or blades, animals, and radio headsets are not allowed in the race and I abide by this guideline. SecureFee™ Registration Cancellation Insurance is offered in most states. If purchased, your registration may be covered for one of the covered reasons stated in the policy.