First name:
Last name:
Age on July 3rd:

Male Female

T-Shirt Size:
XSmall Small Medium
Large XLarge XXLarge


Emergency Point of Contact
Phone Number ( ) -
I accept the Terms and Conditions below


Race Waiver: I, individually, (and/or as parent, and/or guardian of the named minor) for and in consideration of acceptance of this entry in the aforementioned event, do hereby release, remise, waive, and forever discharge the Morningside Baptist Church and any and all other supporting groups of this said racing event, together with all their officers, agents, officials and employees, from any and all liability, claims, demands, actions, or causes of action whatsoever arising out of, or relating to any injury, illness, loss, or damage, including death, relating to participation in the aforesaid event. I further state I am in proper physical condition to participate in this event. I further grant permission to this race and the organization conducting the race and/or agents authorized by them to use any photographs, videotapes, motion picture, recordings and any other record of this event for any purpose. I also agree that if the event is cancelled for any reason that all entry fees are non-refundable and this entry is non-transferable.