Carrollwood Village 5K
Hillsborough County Parks &
Recreation 5K Run Series
Saturday, April 18 2020
Carrollwood Village Park
4680 West Village Drive in Tampa
7:30am Check In 8:30 am Start
Cost $30 per person
Race will be chip timed
Runners will receive t-shirt and medal
All Proceeds will benefit Friends of the County Parks
Name_______________________________ Birthdate: __________ Age: ____ Sex: M F Shirt Size _______
Cell Phone_________________________ Emergency Contact_ __________________________Phone_____________________
Email Address:__________________________________________________________
Running Club: __________________________________________________________
Waiver (MUST BE SIGNED)
In consideration of your accepting this entry, I, the below signed, intending to be legally bound, for myself, my heirs,
my executors and administrators, waive and release and any all rights and claims for damages I may have against the
race, and sponsors and their representatives, successors and assigns for any and all injuries suffered by me in said
event. I attest that I will participate in this event as a footrace, that I am physically fit and sufficiently trained for the
completion of this event. Furthermore, I hereby grant full permission to use my name and likeliness, as well as any
photographs and any record of this event in which I may appear for any legitimate purpose, including advertising and
promotion.
Printed Name___________________________________________________________________
Signature______________________________________________________________________
Date___________________________