2023 4th of July Main Street Mile 
Please use this form to pre-register for the 4th of July Main Street Mile in Derby, VT. All participants must sign up before the day of the race (no race day sign ups), and participant bibs will be handed out the morning of the race.  The race is open to all ages!
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First Name *
Last Name *
Age *
City/Town, State of Residence *
Participant/Parent Email *
Participant/Parent Phone Number *
Emergency Contact Name *
Emergency Contact Phone Number *
Waiver Acknowledgement *
Verplicht
Waiver Acknowledgement:  In consideration of being permitted to participate in Northern Border Running Club’s (“NBRC”) event(s), I agree to assume all risks inherent in participation, whether they are apparent to me or not. I certify that I am in good physical health and fit to participate. Nevertheless, I acknowledge that participation carries an inherent risk of injury to my person and damage to my property. I hereby waive and release, for myself and for my heirs and assigns, any and all claims, causes of action, or liabilities which may hereafter accrue against NBRC, and its affiliates, their agents, employees, volunteers, officers, directors, successors and assigns, and any and all sponsors, their representatives and successors, that may arise as a result of my participation in NBRC’s event, including any and all claims for personal injuries caused by NBRC’s negligence. I also allow the use of any photo of myself, taken during the event, to be used for Club purposes.
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