Center Grove Trails Organization

*First Name

*Last Name

Address

Zip

Phone

*Email

Number of T-Shirts (1 event shirt guaranteed if registered before May 15th. Extras are first come first serve at event.)

Small Medium Large X-Large

Individuals $20/each Groups $25/each (2 adults +up to 5 children)

Enter Total Number of Individuals Total Number of Groups

List Each Participant Name and Age

I, the undersigned, intending to be legally bound, do hereby for myself, executors, and administrators, waive, release, and forever discharge any rights and claims for damages, including claims for loss, damages or injury to my person or property arising out of my participation or failure of participation in the “Blaze the Trail” event and any pre-and post-event activities.  This release applies to the Center Grove Trails, Inc.,  White River Township Government, Johnson County Government, White River Fire Department, Center Grove Community School Corporation, New Hope Church, private property owners, medical assistance providers, and all the sponsors, volunteers, employees and officers of the aforementioned organizations.
I understand that those released encourage participants to consult their doctors in regard to practice, preparation, and participation in the “Blaze the Trail” run and walk event.  To the best of my knowledge and belief I have no physical restriction which would prohibit my participation in the event.  Further, I hereby grant full permission to any and all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose including commercial advertising.