Please one form per person *filled out completely:
* First Name:________________________________________________
*Last Name:________________________________________________
*Address:__________________________________________________
*City:________________________________ State:_________________
*Postal/Zip Code:_____________ Country_________________________
*Day Phone Number:(______) ________ - _____________________
*Evening Phone Number:(_____) _______ - _____________________
*e-mail address _____________________________________________
*Date of Birth:____ / ____ / ________ Age on Race Day ________
*Gender: ____Male ____Female
*Is this your first off-road run? ___YES ___NO
*Were you born in Hawaii? ___YES ___NO
Press Release: I agree to receive mailings from Team Mango Races vendors which,
does not obligate me to purchase any athletic related products.
I GIVE PERMISSION for free use of my name, voice or picture in any broadcast,
telecast, advertising promotion or other account of this event.
Signature__________________________________________________
Under 18 years old must be signed by Parent or Guardian
T-Shirt size:__XS __Sm __Med __Lg __XL __XXL
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Release: I agree to comply with rules,
regulations, and event instructions of the
Kings Trail Summer Solstice Run.
I understand that participating in an
off-road trail event is a potentially
hazardous activity and can result in
serious injury or death.
I am aware of and I expressly assume all
inherent risks associated with
participating in this event, including, but
not limited to falls, contact with other
participants, and objects, the effects of
weather, including high heat and humidity,
traffic, and the condition of the run course
and the finish area.
IN CONSIDERATION of your accepting this
entry, I for myself and anyone entitled to
act on my behalf, waive and release from
any and all claims for injury and damages
I may have against Team Mango Races,
the Village of Kailua, Kona county, the
State of Hawaii, the United States of
America, the Sponsors, USA Track and
Field, their agents and representatives
caused by negligence of any of them
arising out of my participating in this
event, including pre and post-race
activities. I ATTEST that I am physically fit
and have sufficiently trained for
competition of the King's Trail Summer
Solstice Run.
I CONSENT to receive medical treatment
which may be advisable in the event of
illness or injury suffered by me during this
event, and I agree to pay for the costs of
my medical treatment.
Initial ______
Date:___/___/2012
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