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