Name: _____________________________________________________________

Address: ___________________________________________________________

City: ______________________________________________________________

State: _______________________     Zip: ___________     

Age: ____ (As of Aug.7, 2010)     Shirt Size: ____ (S, M, L, XL)     Sex : ____ (M/F)   

Phone: ________________   Email: ________________   Amount enclosed: $__________
Please make checks payable to - Sanpete Valley Health Care Foundation and mail check & form to:

Skyline 10K
Sanpete Valley Health Care Foundation
1100 South Medical Drive
Mt. Pleasant, Utah 84647

Acknowledgement of Risk

I acknowledge that I do understand that this is a high altitude event which requires proper physical conditioning and I recognize that there is an element of risk in any adventure, sport, or activity associated with the outdoors, which could result in physical or emotional injury, death or injury to myself, to property, or to third parties. I am fully cognizant of the risks and dangers inherent in participating in this 10 kilometer race on the Skyline Drive ascending to an elevation of approximately 10,000 feet.  I certify that I and any minor child that I am responsible for are fully capable of participating in the said activity. Therefore, I assume full responsibility for personal injury to myself and/or to members of my family, or for loss or damage to my personal property and expenses thereof as a result of my negligence, or the negligence of any of my family members, participating in said activity, except to the extent that such damage or injury is due to the negligence of the promoters of this event. I further understand that the promoters of this event reserve the right to refuse any person the experience of participating that the promoters judge to be incapable of meeting the rigors and requirements of participating in the Skyline 10K. I have read, understand, and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon the parties in any matter relating to this activity.

Signature:                                                                                            Date:                     

Signature of parent :                                                                              (If entrant is under 18 years old)