Run To The Top Mt. Baldy Ca.

RUN TO THE TOP ENTRY BLANK web page

or

PRINT AND SUBMIT THIS FORM WITH PAYMENT BY MAIL

MAIL CHECK PAYABLE TO: SAN ANTONIO CANYON TOWN HALL
MAIL TO: MT BALDY RUN -TO-THE-TOP, P.O. BOX 681, MT BALDY, CA 91759

LAST NAME ___________________________ FIRST _______________________________________

ADDRESS__________________________________ CITY_____________ STATE___ ZIP_____

PHONE ______-- _______-- _______ BIRTH DATE ____ / ____/ ____ AGE ON RACE DAY _____

NOTE: THIS ENTRY WILL NOT BE ACCEPTED WITHOUT THE PARTICIPANTS SIGNATURE BELOW

The Mt. Baldy Run-To-The-Top is a difficult and potentially treacherous trail race and I am fully aware of the risks involved. I certify that I have the necessary skills and ability to participate in this run and assume full responsibility for myself for bodily injury, death, or loss of personal property as a result of my negligence in this race except for such damage as due to the negligence of the race operator. I will abide by the instructions given to me verbally or in writing. I have read, understand, and accepted the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon me during the entire period of the race.I also certify that I have had a recent physical examination by a physician and/or that I have enjoyed good health, judging from all day to day evidence and that I know of no physical or mental condition which might possibly be aggravated or become hazardous to my health, through my participation in this program, I also recognize that athletes participating in this competition may be subject to formal drug testing in accordance with the USA Track & Field Regulation 10 and IAAF Rule 55. Athletes found positive for banned substances or who refuse to be tested, will be disqualified from this event and will lose eligibility for future competitions.

Signature of parent or guardian if participant is under 18_________________________