Name *

First Name

Last Name

Gender

Male

Female

Phone *

(###)

###

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Payment - Adults $35/ Kids $20 (12 yrs and under) *

Paypal (a link will be sent to you once you submit this form)

Check or Cash (Payable to Silt Historical Park and mailed to 1345 Ballard Ave, Silt CO 81652)

Venmo (Desi-Kirkpatrick (last four of phone number is 3351)

In consideration for being permitted to participate in the Silt Historical Hobble 5k Run/Walk/Hobble in Silt, Colorado on Saturday, July 13, 2024. I hereby agree as follows: I hereby Release and Discharge Town of Silt, Silt Historical Park and the 2024 Rifle Parks and Rec Committee and their officers, directors, agents, employees, volunteers (collectively referred to as “Released Parties”), from any liability, claims, demands or causes of action that I may hereafter have for injuries or damages arising out of my participation in the Silt Historical Hobble 5k race, including but not limited to, losses caused by the negligence of the Released Parties. I further agree that I will not sue or make a claim against the Released Parties for damages or other losses sustained as a result of my participation in the Silt Historical Hobble 5k race. I also agree to indemnify and hold the Released Parties harmless from all claims, judgments and costs, including attorney incurred in connection with any action brought as a result of my participation in the Silt Historical Hobble 5k. This includes any claim for indemnity or contribution brought against the Released Parties. Rifle Parks & Recreation Personal Release Statement and Consent for Treatment I understand that as a registered participant in this program there may be an element of hazard, inherent danger or risk of physical injury, and I take full responsibility for my actions, physical condition, injuries, damages or loss which I may sustain as a result of participating, in any manner, and in any and all activities connected with, or associated with such programs. I agree to indemnify and hold the City of Rifle and its employees from any liability, loss cost or expense (including attorney fees, medical and ambulance cost) that I may incur while participating in Rifle Parks and Recreation activities. In addition, I authorize any medical treatment deemed necessary or appropriate by an emergency technician, nurse or physician in case of illness or injury while participating in any of the City of Rifle programs. I understand that participants involved in Rifle Parks and Recreation programs may be photographed and such photographs may be used to publicize activities. *

I HAVE CAREFULLY READ THIS AGREEMENT AND RELEASE OF LIABILITY AND I FULLY UNDERSTAND ITS CONTENTS.