Mighty Milers Fun Run/Walk Race Release Form

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Parent/Guardian: Entry to the below listed NYRR YCS event is free for Mighty Milers participants. Please fill out this entry form and check off the race for which you are giving the below-named Mighty Milers participant permission to run. Please note that you may need to meet with your Site Coordinator (School Staff) earlier than the times listed below.
First and Last Name of Runner

Street Address:

Apartment #:

City: Phone: School/Team Name:

State: E-mail if available: Grade:

Zip Code:

Check one:

Male

Female

Date

Event

Distance

Time

Location

Weds., June 11 Mighty Milers Fun Run/Walk Pre-K and K

1/4 Mile

Arrive at 9:30 a.m. Arrive at 9:30 a.m.

Icahn Stadium, Randalls Island Icahn Stadium, Randalls Island

1/2 Mile Weds., June 11 Mighty Milers Fun Run/Walk 1st and 2nd Grade Note: In case of inclement weather, this event will be moved to the New Balance Track & Field Center at The Armory (168th St. and Fort Washington Ave.) in Manhattan and become a Fitness Festival.

The undersigned Participant and his/her parent or guardian (collectively, Releasors), in consideration of Participant being provided by New York Road Runners, Inc. (NYRR) with the opportunity to participate in the Mighty MIlers events listed above each hereby voluntarily represents and agrees as follows: 1. That there are inherent risks and the potential for injury that may result from participating in the NYRR event listed above and activities in connection therewith (collectively, the Events), including but not limited to falls; contact with other participants, spectators or others, or vehicular or other traffic; the effects of the weather, including heat and/or humidity, wind, cold temperature, and wet or icy surfaces; falling tree branches or other overhead objects; traffic; and the crowded nature and other conditions of the Event course or facility; and each Releasor hereby assumes all such risks and responsibility for any and all injury, damage or loss that may result from participation in the Events. 2. I represent that my child will not participate in any Events unless he/she is medically able and agree that it is Releasors responsibility to consult with a physician prior to he/she participating in the Events to determine if he/she is medically able to participate in the Events. Releasors hereby authorize NYRR and its employees, representatives, contractors and other agents, including medical providers at the Events, to administer or arrange for any medical assistance that they deem necessary or appropriate as a result of his/her participation in the Events, including without limitation, transportation to a hospital of other medical facility. Releasors further grant access to medical records and physicians, as well as other information, relating to medical care that may be administered to Participant as a result of his/her participation in the Events. 3. For themselves and their representatives, heirs, successors and assigns, do hereby release New York Road Runners, Inc.; U.S.A. Track & Field and its constituent associations; the City of New York, its agencies, departments and officials; and all sponsors and officials of the Events; and the employees, volunteers, including medical volunteers, and other representatives, agents, and successors of each of the foregoing (the Releasees), from present and future claims and liabilities of any kind, known or unknown, arising out of my childs participation in the Events, even though such claim or liability may arise out of negligence or fault on the part of any of the Releasees. 4. Grant permission to the Releasees to use or authorize others to use any photographs, motion pictures, video or sound recordings, or any other record of Participants participation in the Events, including Participants name and likeness, for any purpose without remuneration. 5. Hereby grant permission for Participant to be transported to or from the Events by motor vehicle operated by a licensed operator pursuant to arrangements made by any of the Releasees.

Name of Participant (Please Print)

Signature of Participant

Todays Date

Name of Parent/Guardian (Please Print)

Signature of Parent/Guardian
(please print out and sign this form manuallyonly hand-written signatures will be accepted)

Todays Date