Goffstown Berry Classic
Sat Jul 22, 2017
Individual Entry:7:30 am$25.00
BIB #

(text to be included at the top of the paper application)

Note: Lines 1-4 are mandatory. You cannot be entered into the race if they are not complete and legible.
1First Name 
2Last Name 
3Gender   MALE      FEMALE      (please circle one)
4Age(your age on race day)

5Birthday 
6Address 
7  
8City 
9State 
10Zipcode 
11Phone 
12Email 
13Event T-Shirt
Shirt Size
SmallMediumLargeX-Large
14How did you hear about us? 
15Shirt size? 

Signature: __________________________________________________________ Date ____________________

Parent Signature (if under 18) ______________________________________ Date ____________________

My signature is in agreement to the following Waiver:

I know that running a road race is potentially hazardous activity, which could cause injury or death. I will not enter and participate unless I am medically able and by my signature, I certify that I am medically able to perform this event, and am in good health. I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I attest that I have read the rules of the race and agree to abide by them. I assume all risks associated with running in this event, including but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, inclement weather, road traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and inconsideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Goffstown Historical Society, Town of Goffstown, NH, Granite State Race Services, all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record of this event for any legitimate purpose.