Race: Sunday, December 13, 2015 5K: 8:30am start • Kidz Run 9

Hosted By:
The Sausalito on the Waterfront Foundation & The Dipsea Race Foundation
Race: Sunday, December 13, 2015
5K: 8:30am start • Kidz Run 9:15am start
Sausalito on the Waterfront: 90-0498166
Dipsea Foundation: 68-0405142
in front of the Spinnaker Restaurant, Sausalito
Please Print Clearly, Ineligible Applications May Affect your Entry!
(Only one applicant per application)
First Name ________________________________________________ Initial ________ Last Name ______________________________________________________
Address _______________________________________________________ City ___________________________________________ State _______ ZIP _________
Telephone (Day) ( _______ ) ______________________________________________ Evening) ( _________ ) _____________________________________________
Fax ( _______ ) _____________________________________________
Age on race day_____________
PLEASE CIRCLE ONE:
5K
Birthdate_____/_____/_____________
Email ______________________________________________________________
Gender: M
Kidz RUN
F
T-Shirt Men:
T-Shirt Women:
S
M
L
XL
S
M
L
XL
PLEASE MAKE CHECKS PAYABLE TO: DIPSEA RACE FOUNDATION
Register Online: www.SausalitoJingleBell.com ENTRIES MUST BE RECEIVED BY DECEMBER 7, 2015.
ENTRY FEES: Adults: $40; Children 16 & under: $25; KidzRun (7 and under): $5
Entry Includes a t- shirt to all 5K runners and a mdeal for Kidz Fun Run finishers
Register before December 1st and your entry fee will include a Post-race
Pancake Breakfast from 9am–11:30am in the Winterfest Tent.
MAIL ONLY ENTRY FEE & APPLICATION TO:
Dipsea Race Foundation, P.O. Box 10, Mill Valley, CA 94942
NOTICE: One check (US Banks Only) per application!
THIS IS A LEGAL DOCUMENT WITH IMPORTANT CONSEQUENCES READ IT CAREFULLY ASSUMPTION OF RISK AND LIABILITY
I realize and acknowledge that this event is a foot race over a course which is not designed for crowds. I realize that +/-500 entrants are expected and that weather may make the course hazardous. I
AM FULLY AWARE THAT RUNNING AND WALKING THIS COURSE MAY BE DANGEROUS TO LIFE AND LIMB EVEN UNDER THE BEST OF WEATHER AND TRAFFIC CONDITIONS. I am aware that crowds,
runners, adverse physical conditions and possible adverse weather conditions will result in a hazardous and dangerous condition on the day of the race. I REALIZE AND UNDERSTAND THAT
ENTRANTS MAY BE INJURED, THAT SOME OF THESE INJURIES ARE CERTAIN TO OCCUR AND THAT I MAY SUFFER DEHYDRATION. The costs of any medical/rescue services will be my responsibility. With
full knowledge of all the above facts and warnings, I intend to participate in and/or allow my child/children, ward or wards to participate in the Sausalito Winterfest Jingle Bell 5K & Kidz Run and that
I assume all risks in or related to said participation in the Sausalito Winterfest JingleBell 5K & Kidz Run, including full responsibility for myself, my child/children, ward or wards and all of my and/or
their acts or omissions. In consideration of acceptance of my entry and granting of permission to run in the race, I do hereby for myself, my heirs, assigns, executors and administrators release and
forever discharge the Dipsea Race Foundation, The Dipsea Race Committee, Inc., Sausalito-on-the-Waterfront Foundation; The City of Sausalito, Sausalito Police Department, Sausalito Yacht Harbor,
Clipper Yacht Harbor, Schoonmaker Point Marina, Army Corps of Engineers, Marina Office Plaza, Sausalito Boat Yard and Marina, Sausalito Lion’s Club and the Spinnaker or any of its respective
directors, officers, members, representatives, volunteers, employees, successors and assigns and all other persons and associations from any and all claims and causes of actions by reason of any
injury or injuries, whatever nature, which have or has been sustained or which may be sustained or which has or have been accrued or which may accrue to me or my child/children, ward or wards
as a result of or in conjunction with the Sausalito Winterfest Jingle Bell 5K & Kidz Run, or my traveling to or from the Sausalito Winterfest Jingle Bell 5K & Kidz Run or my entry, participation or related
travel to any of my children or wards. By acceptance in the Race, I agree to abide by all the rules and decisions of the Dipsea Race Foundation, Dipsea Race Committee and Sausalito-on-the-Waterfront Foundation. I grant the release and full use of my name(s) and/or images and those of my children, ward or wards by the Sausalito Winterfest Jingle Bell 5K & Kidz Run. In case of cancellation
there is no alternative race date and there will be no refunds.
APPLICANT:
with the intent to be bound by its terms.
Signature of Runner:______________________________________________________________________
PARENT OR GUARDIAN OF APPLICANT:
both personally and in relation to my child/children, ward or wards, named who has/have my permission to travel to and from to enter and run the Sausalito Winterfest
Jingle Bell 5K & Kidz Run, Sunday, December 13, 2015.
Signature:___________________________________________________________________________________
Print Name / Date:___________________________________________________
___________________
THIS IS A LEGAL DOCUMENT, SIGN AND RETURN
RN: __________________
FOR OFFICIAL USE ONLY
KIDZ RUN 5K
DATE: _________________