RELEASE AND WAIVER: In consideration of the acceptance of my and/or my guests entry, I hereby waive on behalf of my and or my guests heirs, executors and assigns, all claims of any nature arising from my participation of the “Color Run” event and do hereby release Cedarwood/Gardenside/JCHC, the City of Fairbury and any race volunteers of the event from any claim whatsoever arising from my and/or my guest participation in the event. I agree to abide by all the rules for participation. I understand the risks for such a run and have trained adequately in preparation and hereby certify that I and or my guests are insured against accident or injury. I and or my guests release any rights to all photo and video taken during the event and agree to any publications. I hereby certify that I have read and understand this agreement. Participant: Signed: __________________________ Date: ___________________________ RAINBOW RUN All proceeds to RELAY FOR LIFE May 29th @ 6:00 pm (Parent signature required if participant is under 18 years of age) Signed: __________________________ 5k Run/Walk Date: ___________________________ Age: ____________________________ A RELEASE & WAIVER MUST BE SIGNED BY EACH PARTICIPANT. ALL EVENTS WILL BE HELD RAIN OR SHINE. 2 mile Fun Run/Walk Name: ______________________________________ Address: ____________________________________ ___________________________________________ Phone: _____________________________________ Age: _____________ (if child registration) Pre-registration required for shirts: Registration forms available from: Cedarwood Assisted Living, Gardenside LTC, JCHC, Burkley Wellness Center, Globe Rexall Pharmacy and First National Bank. Sponsored by: Cedarwood/Gardenside/JCHC Relay for Life Team. Questions?? Call Becky Bruce at 402-729-6100 * Submit One Form per Participant Must Sign Liability Waiver on the Back. Registration fee $25/Adult & $15/Children under 12 years of age (includes shirt and sack lunch) Check in starts at 5:30, race begins at 6:00 at JCHC/Burkley Wellness Center All Events will be held Rain or Shine. Events: ____ 5K Walk/Run _____ 2 Mile Fun Run/Walk Registration Due by May 16, 2014. Entries submitted after this date do not guarantee a T-Shirt. T Shirt Size (circle one): Adult: Child: S S M M L XL L 2XL 3XL You may return registration form and payment to JCHC, Gardenside or Cedarwood Assisted Living, or mail your registration and payments to Cedarwood AL Attn: Becky Bruce 828 22nd St Fairbury, NE 68352
© Copyright 2024