Wapack Trail Race
September 3, 2017
Entry Form (One for each participant, please)
I, the undersigned, accept full responsibility for myself and for any injuries that I may incur during the 2017 running of the Wapack Trail Race. I have read the information on the race website (wapack.freeservers.com) and I fully understand that participating in this event may be dangerous to my health. Sprained ankles, cuts, bruises, and broken bones are real possibilities, as is severe dehydration. I understand that emergency medical care could take a long time to arrive due to the long distances of the trail from roads and the very difficult terrain. I hereby for myself, heirs, executors, and assigns, waive and release any and all rights and claims for any and all injuries suffered by me, however incurred or sustained, against the organizers, landowners, the Towns of Ashburnham, MA and New Ipswich, NH, the Friends of the Wapack, the Squannacook River Runners, or any race volunteer. I attest that I am physically fit, I understand the difficulties and hazards of trail running, I have trained sufficiently for the completion of this event, and my actions, mishaps, and medical costs are accountable to no one but myself.
Signed__________________________________________(Parent or Guardian)
(if under 18)
Please print (legibly) the information below.
Name__________________________________Age_____Date of Birth___________M O F O
For 2-Person Relay Only (Both must register separately):
Name of Teammate__________________________
Emergency Phone (Please!): _____________________
O $25 if postmarked by 8/26 O $30 after 8/26, including race day
O $10 (Trail Race Directors - pre-registration by mail or e-mail only)
Name of Trail Race and link to a website that shows your role as Race Director:
Please make checks payable to Squannacook River Runners
Mail entries to: Paul Funch, 92 Reedy Meadow Rd., Groton, MA 01450