Dodge City Young Life Zombie Run

Date of Race: Friday, October 17, 2014

Time: Registration 6:00 PM; Run starts at 6:30 PM

Registration will be at the band shell in Wright Park.
If you have any questions, please email Dave at djoseph10@hotmail.com
or call 620-253-4470
--------------------------------------------------------------------------------
Dodge City Young Life Zombie Run Registration
Name:______________________________
Address:_____________________________
Phone Number:_______________ Email:____________________
Cost: 25$

Shirt Size: (circle) SM MED LG XL
Please mail completed form to:
Dave Linsenmeyer
1603 Tomahawk
Dodge City, KS 67801



Dodge City Young Life
RELEASE & INDEMNIFICATION
In consideration of allowing Participant to participate in the Dodge City Young Life Zombie Run Event:
Participant hereby releases and forever discharges
Dodge City Young Life, its Board of Directors, Young Life, its Board of Directors and all other persons,
employees, agents, and volunteers affiliated with the Zombie Run from any and all claims arising out of
participating in the Zombie Run activity. Participant hereby releases and forever discharges, Dodge City Young
Life, its
Board of Directors, agents, servants, representatives, employees, affiliates, partners, predecessors--in--
interest, successors and assigns, and all other persons, firms or corporations in which any of the former have
been or are now or may hereinafter be affiliated, of and from any and all past, present, or future claims,
demands, obligations, actions, causes of action, rights, damages, costs, expenses or compensation of any nature
whatsoever, caused by or brought as a result of Participants acts or omission and arising out of Participants
involvement in a Zombie Rum activity. Participant hereby agrees to defend, indemnify and hold harmless Dodge
City Young Life, and all the above mentioned entities and persons from any claim, demand, obligation, actions,
causes of action, lawsuits, damages,
costs, expenses, attorneys fees or compensation of any nature whatsoever caused by Participants acts or
omissions arising out of Participants involvement in the Zombie Run activity.



HOLD HARMLESS WAIVER DODGECITY
YOUNG LIFE ZOMBIE RUN
Waiver statement (must be signed at registration): As an entrant in the Dodge City Young Life Zombie Run
Event, I assume complete responsibility for personal injury to me or damage to property which may occur
during the event or while I am on the premises of the event. I hereby release and hold harmless the sponsors,
promoters, organizers, and all other persons associated with the event from any and all liability for personal
injury or property damage. I grant permission for any and all of the foregoing to use any photographs, video,
tapes, motion pictures, or any other record of this event for any purpose whatsoever. I have read this waiver,
understand it, and sign below of my own free will.



X_____________________________________________________________
Signature

Date: __________________________________