OCTOBER 11 3-mile fun run - Western Connecticut State University

_____________________________________
3-mile fun run
OCTOBER 11
Date
Participant’s Signature
Date
_____________________________________
Parent’s Signature (if participant is under 18 years of age)
__________________________________________________________ __________________________________________________________ I know that running is a potentially hazardous activity. I should not enter or run this event unless I am medically able and properly
trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated
with running in this race including, but not limited to, falls; contact with other participants; the effects of weather, including high heat
and/or humidity; the conditions of the road and traffic on the course; the effects of the hippie powder clouds, which could include
inhalation and/or ingestion, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and
in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release the
event, and all 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. All fees are nonrefundable.
Western Connecticut State University’s
Recreation department presents:
Waiver
WCSU Employee
ZIP Code
Special Division Registration (you may check only one):
-
Daytime Phone
-
-
Date of Birth
State
This form must be completed and the waiver must be signed (see reverse) in order to participate.
WCSU Alumni
Shirt size: S, M, L or XL
Age
Gender: M or F
Unit or Apt. No.
E-mail Address
Event proceeds to benefit WCSU student
fitness and wellness programs by purchasing fitness
equipment, providing health seminars and sponsoring
wellness activities on campus.
City
Event host: WesternRec.
Street Address
Event Announcements: The chemical composition of
hippie powder is food grade corn starch combined with
food, drug & cosmetic colors and is not hazardous. It
is not intended for human ingestion. Please consider
all allergies and potential risks before deciding to
participate in this event.- A change of clothes is highly
recommended.
Last Name
Registration fee: $10 per person ($15 on event day.)
Participation is free for Western students. Kids 8 and
under are free (no free tee or dye packet.) First 150
registered participants receive a free tee and dye
packet. Additional packets available for purchase.
Race day registration is available.
First Name
Race route: The course will head out of Ives Concert
Park, right onto University Boulevard, right through the
residence halls parking lots, across University Boulevard
and down the Access Road through the softball field.
Then a right onto University Boulevard, down to the
Magnet School and back with the finish back in Ives
Concert Park. Water stations will be positioned along
the course.
Make checks payable to: WesternRec
Mail form & check to: Run or Dye, attn: Amy Shanks, REC Dept-BH 136, 181 White Street, Danbury, CT 06810
Format: The Sunday, October 11, 2015 Run or Dye:
3-mile fun run will begin and end in Ives Concert Park
on the westside campus. All participants will begin the
event at 12 noon. Event day registration from 10-11:30
a.m. A sea of color will be unleashed right before the
start of the run. Then participants will be showered with
color bombs at various points throughout the course.
WCSU Student
Registration Form
[email protected]
(203) 837-8935
Run or Dye: 3-mile fun run