REGISTRATION FORM Participants Name__________________ Date of Birth ____________ Age on day of event________ Circle one

Male

Female

Address_______________ City_________ State_______ Zip______ Phone #________

Email ________________

Circle shirt size: ADULT (scoop neck) XS(32-34)

SM(35-37)

LG(41-43) LADIES (V-Neck)

XS(2) SM(4-6)

LG(12/14)

MED(38-40)

XL(44-46) MED(8-10) XL(16/18)

Please read waiver thoroughly then sign and date I know that running a road race is potentially hazardous activity, which could cause injury or death. I will not enter and participate unless I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this event, and am in good health, and I am properly trained. I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I attest that I have read the rules of the race and agree to abide by them. I assume all risks associated with running in this event, including but no limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I understand that bicycles, skateboards, baby joggers, roller skates or roller blades, animals, and personal music players are not allowed in the race and I will abide by all race rules. Having read this waiver and knowing these facts and inconsideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Fair Day 5k Tater Trot Race, the City of PALMER, VALLEY WOMEN’S RUNNING TEAM, and the Road Runners Club of America, all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record of this event for any legitimate purpose.

Signature______________________________________ Date__________________ Parent’s signature if under 18 years of age______________________ Date____________

REGISTRATION FORM Participants ...

I understand that bicycles, skateboards, baby joggers, roller skates or roller blades, animals, and personal music players are not allowed in the race and I will abide by all race rules. Having read this waiver and knowing these facts and inconsideration of your accepting my entry, I, for myself and anyone entitled to act on my ...

202KB Sizes 1 Downloads 77 Views

Recommend Documents

registration form -
Hypenica. Concrete.TV. Reputable third parties. Terms and conditions* ... It may be necessary for reasons beyond the control of Hypenica to change the content.

Registration Form -
Venue: Dhanmondi Club Limited, Metro Shopping Mall (Level-6), Dhanmondi. Date: 26th October 2015. Time: 7.00 PM. Deadline Date: 22th October 2015.

registration form
(Name of State/Country). MATC appreciates your cooperation in completing the following information, which is needed to meet State and Federal reporting.

Registration Form
Cell Phone (_____)_____-______ ... information and may disclose such information to the above-named Insurance Company(ies) and ... consent will end when my current treatment plan is completed or one year from the date signed below.

Registration Form -
PLEASE TYPE OR PRINT CLEARLY AS YOU WANT IT TO APPEAR ON YOUR CERTIFICATE OF. ATTENDANCE ... Please select one workshop (Limited seats).

Application Form - NRHA Registration Form - Letchworth Roller ...
Application Form - NRHA Registration Form. CLUB NAME. SEASON. SECTION A - Class of membership ( please check box where appropriate ).

Registration form - European Medicines Agency
Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc.

CCC / CCC+ EXAMINATION REGISTRATION FORM
NOTE : ALL INFORMATION SHOULD BE FILL IN ENGLISH CAPITAL LETTERS ONLY. 1 NAME OF SECRETARIAT. : 2 NAME OF DEPARTMENT. : 3 NAME OF INSTITUTE / OFFICE. : 4 OFFICE ADDRESS. : PHONE NUMBER. 5 NAME AND DESIGNATION OF HEAD OF. INSTITUTE/OFFICE. CONTACT NUM

Registration Form NTA.pdf
Page 2 of 2. Registration Form NTA.pdf. Registration Form NTA.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying Registration Form NTA.pdf.

Registration form - European Medicines Agency
Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc.

Registration Form - PharmaFest_17 - Pharmacy.pdf
Page 1. Registration Form - PharmaFest_17 - Pharmacy.pdf. Registration Form - PharmaFest_17 - Pharmacy.pdf. Open. Extract. Open with. Sign In. Main menu.