2015 Nut N’ Butt Shoes WP Fun Mud & Foam 3k Run
In consideration of the acceptance of this entry and being permitted to participate in the Whispering Pines
,WPNR, LLC. Mud Run (“Event”) I freely accept and voluntarily assume the risks of personal injury or
property damage that may result from this potentially hazardous activity. I further agree to waive and
release from all claims and liabilities of any kind arising out of my participation and agree to hold harmless
WPNR and any sponsors or administrators of this event. I, myself, my heirs, executors and
administrators, hereby hold harmless WPNR, LLC., sponsors and administrators associated with this
event. I also authorize the sponsors of this event permission to select location for any medical treatment I
may need in case of an emergency situation. I am at least eighteen years of age or older and execute
this Waiver and Release from Liability with full knowledge and understanding of the terms and conditions
stated on this Waiver.
I am aware that this “Event” will present physical obstacles and physical requirements that are potentially
challenging and hazardous. I fully understand climbing, swimming, crawling and traversing natural and
man-made structures and uneven and rough terrain may present risk to serious injury or death during this
event in addition to the injuries that may occur due to the physical requirements for completion of the
course. I am aware that some obstacles may go through water that has not been treated for chemicals,
disease or contamination. I agree not to dive or enter any mud pit or body of water head first. Shoes are
required. I know and understand that entering any coloration or foam site is potentially hazardous and I
should have protective eye wear, mouth protection or other protection for participation. I attest and verify
that I am physically fit, and have sufficient training and a licensed medical doctor has verified my physical
condition granting me clearance to participate.
I am aware that this is a privately organized event, produced by a for profit, privately held company
(WPNR, LLC.). I agree and accept full responsibility to obey all event rules for safety at the event and
understand that WPNR, LLC withholds the right to dismiss anyone that may cause a disturbance during
this event or disregard the rules with respect to safety.
I certify that I have read and understand the intent of this waiver and release.
______________________________________________________________________
Printed Name
Phone No.
____________________________________________________________________________
Participant Signature
Date
____________________________________________________________________________
Address
City
State Zip
____________________________________________________________________________
Emergency Contact (Name/Phone No.)
Please bring this waiver to the event. You will need to sign this document at the event.
Shirt Size:
S
M
L
XL
Total Paid: _____________
XXL(+2.00)
Race Fee:
Date: _____________
$ 35.00