Brickfest 5K Entry Form
June 27, 2015 -- 7:30am -- Malvern, AR
Last:                                                                     First:

Date of Birth:                           Sex:      M     F                   Age on 6/27/15:


City, State, Zip:


Shirt Size:             S          M             L             XL          

Circle One:          5K Run          5K Walk         5K Wheel

I know that running and volunteering to work in club races are potentially hazardous activities. I should not enter and run in this race unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running and volunteering to work in club races including, but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Brickfest 5K, the city of Malvern, Arkansas Runner LLC, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the race and/or club activities even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver.  I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.

Signature:                                                                                                          Date:

Parent Signature if under 18 years:                                                                   Date:

Make checks payable to Malvern Brickfest 5K and mail to:
Dale Burns
1200 Clardy Street
Malvern, AR  72104

Fees:  pre-registered $20, race day $25
Students (18 & under): $7 pre-registered, $10 day of race

Directions:  Exit 98 off I-30, turn right at Summit Bank just past second traffic light.  Awards will be across highway at 4-H building approximately 45 minutes after race.