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2012 Heritage Explorer Festival Youth Run PROGRAM WAIVER The undersigned is the parent or legal guardian of the minor whose name appears on the bottom of this form. I understand that running is a potentially hazardous activity. I understand that the minor should not enter and run unless medically able and properly trained. I agree to abide by any decision of a race official relative to the minor’s ability to safely complete the run. On behalf of the minor for whose benefit I am executing in this waiver, I assume all risks associated with running this event including, but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road or track all risks being known and appreciated by me. Having read this waiver and knowing these facts in consideration of your accepting my entry, I, for myself, the minor, and anyone entitled to act on my behalf, or on the minor’s behalf, waive and release the LHVA, its officers and agents, the Scranton Running Company, its officers, agents, and employees, the City of Blakely, all sponsors, representatives and successors of the minor’s 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 further authorize and empower the event director to consent to and authorize any medical care or treatment for the minor which may appear reasonably necessary as a result of emergency, accident, or illness of the minor whether occurring before, during or after the event. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this for any legitimate purpose. **PARENT OR GUARDIAN MUST BE PRESENT TO SUPERVISE YOUR CHILDREN**

2012 Heritage Explorer Festival Youth Run Name ________________________________________________________________________ Address ______________________________________________________________________ City _______________________ State ____________________ Zip _____________________ Phone ________________________ Date of Birth ______________ Age as of June 12th _____ Make check out and mail to: Scranton Running Company 3 West Olive Street Scranton, PA 18508

I have read the waiver above and agree to its terms and conditions (sign and date below).

Signature _________________________________________Date___________________