5K Run/Walk
Registrant Information:
Saturday, May 2, 2015
7:30AM Registration
9AM Run 10:30 Awards
Name: ___________________________________
Address: __________________________________
Location: Whitford Park
625 North River Road
Waterford, WI 53185
City, State Zip: ______________________________
Phone: ___________________________________
Email: ___________________________________
Emergency Contact: __________________________
Sex:
 Male
 Female
Register by April 23
T-Shirt Size Adult:
To Reserve Your
FREE T-Shirt
Contact’s Phone: ________________
T-Shirt Size Student:
S
M L
 6-8
 XL  2XL
 10-12
 14-16
*By entering my name below, I warrant the information I have entered is accurate and agree to all of the
agreements/waivers listed on the reverse side. If no agreement/waiver on reverse side, I agree to the terms
of the waiver as shown on the icare-local.org website. T-shirts available after April 23 on a first come-first
served basis at the event.
If participant is under 18, parent or guardian must sign.
__________________________________
Name (Printed)*
__________________________________
Signature*
_______________
Date
FEE DONATION INCLUDED:  $15 Adult
 $10 Student age 5-17
Under 5 free-no t-shirts
Please Make Checks Payable to Community United Methodist Church with iCare in the Memo.
Guiding people to
HELP and HOPE




Community Education
Training
Group & Individual Support
Resource Directories
At the Run Site
Find out how you, too can show
iCare
TAKE BACK OUR
COMMUNITY
Help Us Fight the spread of
Heroin and other drugs
Informational Booths
Food
Racine Co Sherrif’s K9 Unit
DRUG DROP OFF DISPOSAL
BRING YOUR UNUSED MEDS
All Drugs Accepted-No Questions Asked
(No Dirty Sharps)
RETURN REGISTRATION
And Payment to:
iCare
℅ Community United Methodist Church
455 South Jefferson Street
Waterford, WI 53185
Or See icare-local.org
QUESTIONS:
Phone Cindi @ Integrity: 262-514-4600
Email: [email protected]
When you don’t know where to turn for help: icare-local.org
Mission: Saving and Improving Lives by Showing I Care.
By signing on the reverse side you indicate your acceptance and that you understand, agree, warrant and covenant as follows:
iCare and Community United Methodist Church REGISTRATION AGREEMENT AND LIABILITY WAIVER (the Agreement and Waiver)
1.
2.
3.
4.
5.
6.
Waiver. I know that running a road race is a potentially hazardous activity. I should not enter and run 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 this event, which cannot be eliminated completely, ranging from minor injuries to catastrophic injuries,
including, but not limited to tripping and falling, contact with other participants, the effects of weather, traffic and the conditions of
the road and death, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in
consideration of acceptance of my entry, I, for myself and anyone entitled to act on my behalf, waive and release iCare and
Community United Methodist Church, its subsidiaries and affiliates, The City Village of Waterford, The Village of Rochester, The
County of Racine, WE Energies, all sponsors, contractors and volunteers, 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. I grant permission to all of the foregoing to use my photographs,
motion pictures, recordings, or any other record of this event for any legitimate purpose and I understand that my name may be
posted on the iCare website or in publicity materials as a participant of the 2014 event. I also understand that my entry fee is nonrefundable. A parent must sign if entrant is under 18 years of age. This is to certify that my child has permission to compete in the
event, is in good physical condition and the event officials may authorize necessary medical treatment. I understand that bicycles,
skateboards, baby strollers, roller-skates or blades, animals and headsets are not allowed in the race and I will abide by this
guideline. No refunds, transfers or rollovers will be given for entry fees paid.
Authority to Register and/or to Act as Agent. You represent and warrant to iCare and Community United Methodist Church that
you have full legal authority to complete this event registration on behalf of yourself and/or any party you are registering (the
Registered Parties), including full authority to make use of the credit or debit card to which registration fees may be charged. As
used in this Agreement and Waiver, “iCare” refers to the iCare volunteer group, Community United Methodist Church, and any and
all subsidiaries, affiliated entities, or entities that control or are controlled by iCare and Community United Methodist Church singly
or together and its board members, employees, sponsors, volunteers, contractors, subcontractors and agents. If you are registering
a child under the age of 18 or an incapacitated adult you represent and warrant that you are the parent or legal guardian of that
party and have the legal authority to enter into this agreement on their behalf and by proceeding with this event registration, you
agree that the terms of this Agreement and Waiver shall apply equally to all Registered Parties. By registering a child under 13, you
agree and consent to the collection of that child’s information, which you provide for the purposes of registration.
Limitation of Liability; Disclaimer of Warranties. iCare and Community United Methodist Church SHALL NOT BE LIABLE FOR
ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES, RESULTING FROM (A) THE USE OR THE INABILITY
TO USE THE REGISTRATION SITE OR (B) FOR THE COST OF PROCUREMENT OF SUBSTITUTE GOODS AND SERVICES OR (C)
RESULTING FROM ANY GOODS OR SERVICES PURCHASED OR OBTAINED OR TRANSACTIONS ENTERED INTO THROUGH THE
REGISTRATION SITE OR (D) RESULTING FROM UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONS OR DATA,
INCLUDING BUT NOT LIMITED TO, DAMAGES FOR LOSS OF PROFITS, USE, DATA OR OTHER INTANGIBLES, EVEN IF ICARE OR
COMMUNITY UNITED METHODIST CHURCH HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. YOU EXPRESSLY AGREE
THAT USE OF THE REGISTRATION SITE IS AT YOUR SOLE RISK. THE REGISTRATION SITE IS PROVIDED ON AN ‘AS IS’ AND ‘AS
AVAILABLE’ BASIS. ICARE AND COMMUNITY UNITED METHODIST CHURCH EXPRESSLY DISCLAIMS ALL WARRANTIES OF ANY KIND,
EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR
PURPOSE OR NON-INFRINGEMENT.
ICARE and COMMUNITY UNITED METHODIST CHURCH makes no warranty that the Registration site’s services will be uninterrupted,
secure or error free. ICARE and COMMUNITY UNITED METHODIST CHURCH does not guarantee the accuracy or completeness of any
information in, or provided in connection with, the Registration site. ICARE and COMMUNITY UNITED METHODIST CHURCH is not
responsible for any errors or omissions, or for the results obtained from the use of such information. You understand and agree that
any material and/or data downloaded or otherwise obtained through the use of the Registration site is at your own discretion and
risk and that you will be solely responsible for any damage to your own computer system or loss of data that results from the
download of such material and/or data.
Indemnification. You agree to indemnify and hold ICARE and COMMUNITY UNITED METHODIST CHURCH harmless from and
against any and all damages, costs, claims or demands, including reasonable attorneys’ fees, made by any third party due to or
arising from or relating to your use of the Registration Site or the violation of any term of this Agreement and Waiver as well as the
Terms of Service by you.
Applicable Law; Consent to Jurisdiction. ICARE and COMMUNITY UNITED METHODIST CHURCH is located within the State of
Wisconsin, United States of America. By completing this event registration, both you and ICARE and COMMUNITY UNITED
METHODIST CHURCH agree that the statutes and laws of the State of Wisconsin, without regard to the conflict of laws principles
thereof, will apply to all matters relating to this event registration, this Agreement and Waiver, the Terms of Use or other use of the
registration sites. You agree that exclusive jurisdiction for any dispute with ICARE and COMMUNITY UNITED METHODIST CHURCH
resides in the courts of the State of Wisconsin and you further agree and expressly consent to the exercise of personal jurisdiction in
the courts of the State of Wisconsin in connection with any dispute including any claim involving ICARE and COMMUNITY UNITED
METHODIST CHURCH or its affiliates, subsidiaries, employees, contractors, officers, directors, sponsors and volunteers.
Severability. You further expressly agree that this Agreement and Waiver is intended to be as broad and inclusive as is permitted
by the law of the State of Wisconsin and that if any provision of this Agreement and Waiver shall be found to be unlawful, void, or
for any reason unenforceable, then that provision shall be deemed severable from this Agreement and Waiver and shall not affect
the validity and enforceability of any remaining provisions.
BY INDICATING YOUR ACCEPTANCE OF THIS AGREEEMENT AND WAIVER, YOU ARE AFFIRMING THAT YOU HAVE READ AND
UNDERSTAND THIS AGREEMENT AND WAIVER AND FULLY UNDERSTAND ITS TERMS. YOU UNDERSTAND THAT YOU ARE GIVING UP
SUBSTANTIAL RIGHTS, INCLUDING THE RIGHT TO SUE. YOU ACKNOWLEDGE THAT YOU ARE SIGNING THE AGREEMENT AND WAIVER
FREELY AND VOLUNTARILY, AND INTEND BY YOUR ACCEPTANCE TO COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO
THE GREATEST EXTENT ALLOWED BY LAW.
Mission: Saving and Improving Lives by Showing I Care.