I hereby release the Town of Yorktown and Yorktown Chamber of Commerce and all municipal agencies whose property and/or personnel are used and other sponsoring or co-sponsoring company(ies), or individual(s) from responsibility or any injuries or damages I may suffer as a result of my participation in the 2016 Four for the Fourth Run/Walk and/or related events. I hereby certify that I am in good condition and able to safely compete in this event. I additionally permit the use of my name and image in broadcasts, telecasts, newspapers, brochures, etc. I also understand that the entry fee is nonrefundable. I certify that all information provided in this form is true and complete. I have read the entry information provided for the event and certify my compliance by signature below. Bib numbers are non-transferable. NO REFUNDS. IF PARTICIPANT IS UNDER AGE 18: This certifies that my child has my permission to compete in the Run/Walk, is in good physical condition, and that race officials have my permission to authorize emergency treatment if necessary. I hereby give you my permission to have photos of myself or my child taken during this event for promotional purposes.