On Site E-SIGNATURE PAGE - Breakaway Athletic Events

Name*

First Last

Email*

Date Of Birth*

Event / Race*

BIB NUMBER*

I accept the terms, conditions & waivers*

I have read and agree to all Breakaway Athletic Events Terms, Conditions, Rules & Policies *
I have read & agree to all terms & conditions stated in the Breakaway Athletic Events Waiver and Release of Liability / Assumption of Risk and Indemnity Agreement

YES

Sign Initials of Participant in agreement or Parent/Guardian of Participant under 18*

I agree to all USAT and/or USATF terms, conditions & waivers*

I have read and agree to all USAT Terms & Conditions
I have read and agree to all USATF Terms & Conditions

YES

Initials of athlete over 18 years of age or parent/legal guardian of minor under 18 years of age or legal guardian of incapacitated and/or mentally challenged person*

E-SIGNATURES