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Make checks payable to: Helderberg Family & Community Org.
Mail To: PO Box 115, Knox, NY 12107
One person per entry form - please
Shirt Size: (Circle one): Adult sizes : S M L XL 2XL
Name ___________________________________________Age ______ Sex ________
Email _________________________________________________________
Address______________________________________________________________________________Phone#_________________________________________
City____________________________________________
State _______________Zip _______________________
Emergency Phone # during race _________________________________________
I am physically fit to participate in this event. I am participating in this event with the knowledge of the potential hazards involved and hereby agree to accept all risks of injury. I agree that my assignees, heirs, distributes, guardians and other legal representatives will not make a claim against, or sue for injury or damage resulting from the negligence or other acts, howsoever caused, by an agent or volunteer of the organization as a result of my participation in this event. I hereby release the Town of Knox, Albany County, the Helderberg Family & Community Org. and its officers, and all event volunteers and officials from all actions, claims or demands that I, my assignees, heirs, guardians, and legal representatives now have or may hereafter have for injury resulting from my participation in this event.
Signature ________________________________________________________(parent's/guardian signature if under 18)
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For more info email us at connect@helderbergfco.com or call 518-925-3227
Volunteers are welcome.
Just contact us at the email below to
let us know you will help out.
www.Helderbergfco.com
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