Coal Country Form - Saskatchewan Games Council

PLEASEPRINTCLEARLYANDCOMPLETEALLOFTHEFOLLOWINGINFORMATION:
RaceParticipant’sName
Mrs._____Mr._____Miss_____email:_______________________________________________________________
FIRST:_______________________________________________LAST:______________________________________________________
Sex(M/F)______AGE(onraceday)________T-ShirtSize(adult)SM________MD________LG________XL________
Address________________________________________________________City______________________________________________________
Province________PostalCode__________________________________Phone#_______________________
PLEASEREADCAREFULLY*RELEASE&WAIVER*AWARENESSOFRISK
IacknowledgeandagreethatrunninginaroadraceisapotentiallyhazardousactivityandthatIshouldnotenterandrununlessI
ammedicallyableandproperlytrained.Ialsoacknowledgeandagreethatalthoughtraficcontrolwillbeprovidedtherewillbe
traficonthecourserouteandaccordinglyIassumetheriskofrunningintrafic.Ialsoassumeanyandallotherrisksassociated
withrunningintheRaceincludingbutnotlimitedtoslipsandfalls,contactwithotherparticipants,theeffectsoftheweather,
includingrainandhighheatandtheconditionoftheroads,allsuchrisksbeingacknowledgedandappreciatedbyme.Acknowledgingthesefacts,andinconsiderationofyouracceptingmyentry,Iherby,formyself,myheirs,executors,administratorsand
anyoneelsewhomightclaimonmybehalf,covenantnottosue,andherebywaive,releaseanddischargeTheCoalCountryRun
andallofitssubsidiaries,thecommittee,oficialsandvolunteersworkingontheeventday,RaceSponsors,andotherparticipants
intheRaceandalltheiragents,employees,assignsandanyoneelseactingfororontheirbehalf(collectively,the“Indemnities”),
fromandagainstanyandallclaimsfordeath,personalinjuryorpropertydamageofanykindornaturewhatsoeverarisingoutof,
orinthecourseofmyparticipationinthisRaceotherthanasaresultofthegrossnegligenceoftheIndemnities.ThisReleaseand
Waiverextendstoallclaimsofeverykindornaturewhatsoever,foreseenorunforeseen,knownorunknown.Applicationsfor
minors(thoseunder18yearsofage)willbeacceptedonlywiththeminor’sandoneofhis/herparents’signatures.Iherbygrant
fullpermissiontoTheCoalCountryRuntouseanyphotographs,videotapes,motionpictures,recordings,oranyotherrecordof
thisRaceand/orofmeormyminorchildasaparticipantinthisRaceforanylegitimatepurpose.Iherbyacknowledgehavingread
thisReleaseandWaiverandbyacceptingaracenumberIunderstandandacceptitstermsandconditions.
____________________________________________________________________________________________________________
SignatureofparticipantDate
Signatureofparent/guardian(ifparticipantis18orunder)
(PleaserefertoRegistrationInformationforfeestructureanddeadlines)
_____Cheque_____Visa_____Mastercard
PaymentMethod:Cash
IAMENTERING:_____10KRoadRace(timed)
_____5KRoadRace(timed)
_____5Kor_____10KWalk
____MiniMile
WePreferthatyoupaywithCheckorCash,unlessregisteringonline.
CardHolder’sName:________________________________Signature______________________________________Expiry:___/___
Walk / Run
&
“Kids Mini Mile”
Proceeds go to 2016
Saskatchewan Summer Games
Committee
May 9, 2015
Estevan Woodlawn Park
__________________________________________________________________________________
AMOUNTPAIDORENCLOSED$_______________________
10 K — 5 K
Start/Finish @ Souris Valley Theatre
THREE EASY WAYS TO REGISTER
INDIVIDUALFEESFOR5K&10K
1. GoogleRunningroom.com
REGULAR -racesinSaskatchewan
-racesinMay,2015
(untilApril20)
LATE
-clickon“CoalCountryRun”
$35.00
$50.00
(allentriesafterApril20)
2.Completetheformonbackanddropoffat:
-1454NicholsonRd.Estevan
-HendersDrugs
•
5K&10Kparticipantsunder
age16years$20.00
(untilApril20)
•
3.Completeandmailyourentryandsigned
Coal Country
YouthLATEfee$35.00
(allyouthentriesafterApril20)
T-Shirtordercutoff—April20th.
waverto:
Run 2015
May 9
(t-shirtsmaybeavailable-sizechoicenotguaranteed)
CoalcountryRun
DebbyKnight
1454NicholsonRd.
YourFeeGetsYou:
Estevan,SKS4A1T8
•
CommemorativeT-Shirt(ifregisteredbyApril20)
•
PostRaceBrunch
•
RacePkg.withBibNumber&Goodies
•
DoorPrizes
•
Achancetowinmedals—top3inishersawardedinyourage&gendercategory:
Under1616—30
31—4445-55
Over55
“Kids Mini Mile”
Youmustbe15oryoungerparticipateinthe
KidsMiniMile
Everyparticipantinthe“KidsMiniMile”
willreceive;
Finisher’sMedal
FreeT-Shirt
Freelunch
DoorPrizeChance