Shelbyville, KY

September 3, 2011

Part of the Sixth Street Live

Music Festival

This is a family event, part of the Sixth Street Live Activities. Come run to win or to walk with your children. The object is to get as many people as possible physically active. There is no time limit and first timers are encouraged to participate. After the race stay around listen to the great bands, eat at local restaurants and socialize with old and new friends

The 5K Course is a loop around Shelbyville. The course will start on Sixth Street. There will be rolling hills along the route. The finish will be on Sixth Street in front of the stage with a live band playing

Registration will be accepted by mail or online at active.com. We urge you to register by Aug 25 to avoid the late fee, however, you may register on race day.

Name(Last)_____________________________(First)_______________________________Age_________

Address____________________________________________________Birthdate___________________

City_______________________________State_______Zip_____________ Phone______________________

Entry Fee: $20 prior to Aug 25 Email__________________________________________________

Release of Responsibility:_____________________________________________ Date______________

Make Checks payable and mail to Headfirst Performance, 7024 Buckcreek Rd., Finchville, KY 40022

1. I hereby agree to comply with all the rules and regulations and event instructions of the Sixth Street Live 5K and its directors.

2. For myself, my executors administrators, heirs, next of kin, successors and assigns, I HEREBY:

(a)waive and release any and all claims that I may have against the Sixth Street Live 5K, its event committee, their officers, directors, members, volunteers, employees, sponsors or any one or more of them their executors, administrators, heirs, next of kin, successors or assigns ("their releases") including any and all claims for damage caused by the negligence of any them, arising out of my participation in the event and its related activities, together with any cost, including attorney’s fees, that may be incurred as a result of any such claim whether valid or not, and (b)indemnify and hold harmless the releases and each of them against any such claim that I or my guest or any one or more of my or their executors, administrators, heirs, next of kin, successors or assigns may have or assert and against any cost including attorney’s fees with respect therto.

3. I hereby acknowledge that I have sole responsibility for my personal possessions and athletic equipment during the event and its related activities.

4. I hereby acknowledge that participation in this event carries with it potential hazard. I therefore release the Sixth Street Live 5K, its event committee, their officers, directors, members, volunteers, employees or sponsors of any liability resulting from injury or death during the event and its related activities.

5. I hereby attest and verify that I am physically fit and have sufficiently trained for this competition and that my physical condition has been verified by a licensed medical doctor.

6. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during the event.

7. I hereby agree that in the event of race cancellation due to storm, rain, inclement seas, or weather, winds or other "Acts of God" conditions, my enrollment fee shall be non-refundable.

Signature_________________________________________________ Date__________________