On Line Training Begins January 15, 2012






In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for any claims damages I may have against any of the sponsors, volunteers, organizers, City of Shelbyville,  Major Hospital, Shelby County Athletic Club,  Energy2Action, LLC, and The Shelby Roadrunners,  and Steve Gosnell, for any and all claims of damages, demands or loss actions whatsoever which may arise as a result of my participation in this training program and are more fully described below.  I understand and acknowledge that participating in this program may expose me to dangers from both known and anticipated risks.  I understand that the run courses are not closed to traffic and unsupervised.  I acknowledge that I  could be at risk from traffic, other runners and cyclists, bad weather, ice and rough terrain along the run courses or on my way to class.  I acknowledge that some sections of the run  courses may be off road or rough road and may contain areas where I will  be at risk of tripping and falling.  I attest and verify that I am physically fit and have sufficiently trained for the completion of this program and my physical condition has been verified by a licensed medical doctor.  I understand that I may incur permanent injury and I agree that I will monitor my own needs and progress and will not hold any other party responsible for any injury that I may incur.  I understand that this program may be canceled or delayed for any legitimate purpose or reason and that my entry fee will not be refunded under those circumstances or for any other reason.   Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.
Age on 1/15/12:
E-mail:
Zip:
State:
City:
Address:
Full Name:
Current Training Level:
Energy2Action Half Marathon
On Line Training Program
I agreeI do not agree
Walker
Beginner Runner
Intermediate Runner
Advanced Runner