DAVY CROCKETT BEAR CHASE

Please mail completed application to:
Davy Crockett Bear Chase
19903 January Dr.   
Humble, TX 77346

For additional information contact Steve or Paula Boone, cell phone 713-826-5833, email  steveboone@aol.com
Name _____________________________________                    Male / Female
Address ___________________________________                    City, State, Zip ______________________________________________    
Bib Name ____________________________________
Marathon    Half marathon    5K    Possum Walk     Bear Chaise  (circle one)
Is this your first marathon (26.2 miles)?     Y / N                     Number of completed marathons (26.2 miles)  __________  Name on bib ____________________________________________________
Are you a member of the 50 States Marathon club?  Y/N   Member of Marathon Maniacs?   Y/N
Phone (day) ________________ night ________________         Age on race day _____
Email address ___________________________________           Birth date ___________
Emergency contact name ___________________________________ Emergency phone ________________

Fees:
Marathon           $65 (thru 1/31)    $70 (2/1 thru 3/10)  $ 80 (3/11 thru 3/29) $90 Race Day  
Half Marathon   $65 (thru 1/31)    $70 (2/1 thru 3/10)  $ 80 (3/11 thru 3/29) $90 Race Day  
Marathon/Half long sleeve shirt size S / M / L / XL / XXL / XXXL

5K                     $25 (thru 3/10)       $30 (3/11-3/29)       $35 Race Day  
5K short sleeve shirt size child S / M / L  adult S / M / L/ XL / XXL / XXXL 
                                                                                                   
Possum Walk     $15     short sleeve shirt size child S / M / L  adult S / M / L/ XL / XXL / XXXL                                                                                                                                                                   
Bear Chaise        $20     short sleeve shirt size child S / M / L  adult S / M / L/ XL / XXL / XXXL                                                                                                                                                                                                                                                
Make check payable to: Trinity County Chamber of Commerce     Total Enclosed    $ ________

Waiver Must Be Signed
Waiver: All participants in the Davy Crockett Bear Chase events assume all risk of participation in the marathon by signing the release agreement.  I the undersigned athlete on behalf of myself and on behalf of my heirs, my executors, my administrators and my trustees, waive and release any and all rights and claims for any loss(es), injuries and damages including, but not limited to demands or actions for negligence, premises liability, emotional injury, intentional conduct, tort claims, and any other actions or demands of whatever nature, I have or may have against 1) The Davy Crockett Bear Chase, 2) its officials, agents and representatives, 3) all sponsors of the event in which I may participate whether my participation is as a contestant or as a spectator.  I acknowledge that I am aware of the inherent risks involved in this event and I voluntarily assume the risks.  I attest and verify that I am physically fit and I have sufficiently trained for the competition of the above-mentioned event in which I participate.  I hereby grant full permission to any and all of the foregoing to use my name, and/or my picture in any account of this event for any purpose whatsoever.  I have read the entry information provided for the event and certify my compliance by signing below.  Athlete acknowledges that the entry fee is non-refundable and non-transferable.
Signature of athlete_______________________________ Date ___________
* Signature of parent/guardian ______________________ Date ___________
*(if athlete is under 18) I certify that my son/daughter has my permission to compete in the Davy Crockett Bear Chase, is in good physical condition and that race officials have my permission to authorize emergency care if necessary.