Mad Hatter ENTRY FORM – 5K RUN/WALK, 1 Mile Fun Run/Walk
$15 – 1 Mile Fun Run through April 8th
$20 – 1 Mile Fun Run Same Day Registration – April 9th
$20 – 5K Pre-registration thru March 15th
$25 – 5K Pre-registration March 16th to April 8th
$30 – 5K Same Day Registration - April 9th
$10 – Child’s 1 Mile/5K, $5 per additional child (ages 12 and under)
Make Checks Payable to:
Junior Auxiliary of Slidell
P.O. Box 1486, Slidell, LA 70459
Email [email protected] for credit card invoicing.
Email [email protected] for special group rates (of 10 or more).
Last Name _________________________________First Name _____________________________
Address __________________________________________________________________________
City, State, Zip _____________________________________________________________________
Telephone _________________________________Email __________________________________
Age _____ Sex _______
☐ 5K
☐1Mile
Shirt Size (size guaranteed with pre-reg):
__YS__YM__YL
__S __M __L __XL__XXL
WAIVER OF LIABILITY - READ CAREFULLY
For myself and my estate, heirs, executors and assigns, I hereby release and hold harmless Junior Auxiliary of Slidell, NAJA, their respective officers, directors, agents and employees, the race director, and their agents
and sponsors and event volunteers, their representatives and successors (collectively, the Releasees), from any liability whatsoever, however caused, for any and all damages or claims for any loss illness, personnel
injury, death, or property damage arising out of or connected with the Mad Hatter 5k Fun Run (the “Mad Hatter Fun Run”), whether caused by the negligence of Releasees or otherwise. I fully understand that there are
potential risks and hazards associated with the Run. I know that running a road race is a potentially hazardous activity and that I should not enter and run unless I am medically able and properly trained. I agree to
abide by any decisions of a race official relative to my ability to safely complete the run. Despite the potential risks and hazards, I wish to proceed, assumed all risks and hazards that may arise including those
participating to falls, contact with other participants, the effect or weather, traffic and conditions of road, whether caused by negligence of Releasees or otherwise. I further agree to defend, indemnify and hold
harmless the Releasees from any claims, liabilities or costs, including attorney fees, that Releasees may incur as a result of my participation in the Run. I agree that Releasees may photograph me with a camera or other
photographic, recording or electronic medium and consent to use, publication or display of any such recordings for any promotional or educational purpose and waive all claims for compensation.
Prohibited from course: bikes, roller skates and dogs.
"Race and walk will be rain or shine and there will be no refunds"
Signature (under 18, parent signature) ____________________________________Emergency Contact No. _____________________