Colchester Half Marathon
Sat Feb 23, 2019
Half Marathon:10:00 am$14.00
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
Men Small YellowMen Small Royal BlueMen Medium YellowMen Medium Royal Blue
Men Large YellowMen Large Royal BlueMen X-Large YellowMen X-Large Royal Blue
Men 2-XL YellowMen 2-XL Royal BlueWomen Small YellowWomen Small Royal Blue
Women Medium YellowWomen Medium Royal BlueWomen Large Royal BlueWomen Large Yellow
Women X-Large YellowWomen X-Large Royal BlueWomen 2-XL YellowWomen 2X-L Royal Blue

Signature: __________________________________________________________ Date ____________________

Parent Signature (if under 18) ______________________________________ Date ____________________

My signature is in agreement to the following Waiver:

In consideration of acceptance of this entry, I the undersigned, intending to be legally bound, do hereby for myself, my children, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against any and all race sponsors, directors, volunteers, hired services, facilities, or the cities and towns in which this event is contested, their representatives, successor or assigned, including but not limited to the Town of Colchester, Bacon Academy, The Hartford Track Club, the Town of Lebanon, and the State of Connecticut for any injuries suffered by me in said event or to and from such event. I realize that this event is run on public roads and there is little or no traffic control provided and that I participate in this event at my own risk. I attest and verify that I am physically fit and sufficiently trained for completion of this event and a licensed medical doctor has verified any physical condition within the last six months. Further, I hereby grant full permission to any and all of the foregoing to use my photographs, videotapes, motion pictures, recordings, and any other record of this event for any purpose without compensation or remuneration. I also give my permission and consent to act in my behalf to authorize medical treatment should it be required.