Marden Marathon
Saturday, April 11th, 2015
Proceeds from this event donated to
Groves Hospital Foundation
To register online or for more race information visit: www.mardenmarathon.ca
RUNNER DETAILS (please print)
Last Name: __________________________
First Name: ________________________
Address: _______________________________________________
_______________________________________________
City: _________________________
Province: _____________________
Postal Code: _____________________
Country: _____________________
Phone Number: _______________________
Email: ________________________________________
Date of Birth: ________ ________ ________
Sex: F M Month
Day
Year
ALL participants must sign waiver on reverse.
If under 18, parent/legal guardian signature required.
RACE SELECTION
( select your race option)
Half-Marathon Entry Fees
Dec 1 – Dec 31/14
Jan 1/15 – Feb 28
Mar 1 – Mar 31
Apr 1 – Apr 11
$45
$65
$75
$85
10K Entry Fees
Dec 1 – Dec 31/14
Jan 1/15 – Feb 28
Mar 1 – Mar 31
Apr 1 – Apr 11
$35
$45
$55
$70
5K Entry Fees
Dec 1 – Dec 31/14
Jan 1/15 – Feb 28
Mar 1 – Mar 31
Apr 1 – Apr 11
$35
$30
$40
$45
Please if this is your first
race…
5 km
10 km
Half-Marathon
10K (under 19)
Dec 1/14 – Apr 11/15
$25 5K (under 19)
Dec 1/14 – Apr 11/15
$25 To register a
team or for
special
promotions - visit
our website!
Family Fun Run/Walk – Free!!
Name:
Age:
_______________
______
_______________
______
_______________
______
_______________
______
_______________
______
Family Fun Run/Walk
Dec 1/14 – Apr 11/15 FREE Technical T-SHIRT OPTION
PAYMENT
T-Shirts are $12. Deadline to order is March 21, 2015.
Race Fee
$__________
Circle choice of size.
T-Shirt (opt.)
$__________
Women’s S
M
L
XL
Donation to Groves (opt.) $__________
Men’s S
M
L
XL
XXL
Total
$__________
Payment Attached: Cash
Debit
Refund & Payment Policy:
Cheque
• Sorry, no refunds, no transfers, no deferrals. Sorry, no post-dated cheques.
Office Use Only:
form/payment rec’d
Make all cheques, money orders, and bank drafts payable to: Elora Road Christian School Date
_____________________
Initials __________
Marden Marathon
Saturday, April 11th, 2015
Proceeds from this event donated to
Groves Hospital Foundation
RELEASE WAIVER AND INDEMNITY - PARTICIPANT
In consideration of the acceptance of my application and the permission to participate as an entrant or competitor
in the 2015 MARDEN MARATHON including the HALF-MARATHON, 10K, 5K, and FAMILY FUN RUN/WALK on
Saturday, April 11, 2015, I, for myself, my heirs, executors, administrators, successors, and assigns HEREBY RELEASE,
WAIVE, AND FOREVER DISCHARGE Guelph/Eramosa Township, Wellington County, The City of Guelph, The Ontario
Provincial Police Services, St. John’s Ambulance, Royal Distributing Athletic Performance Centre, Elora Road Christian
School, Elora Road Christian Fellowship Inc., Groves Medical Community Hospital Foundation, all Marden Marathon
race committee persons, course officials and volunteers, and all other associations, sanctioning bodies and
sponsoring companies, and elected and appointed officials, successors and assigns, OF AND FROM ALL claims,
demands, damages, costs, expenses, actions and causes of action, whether in law or equity, in respect of death,
injury, loss or damage to my person or property HOWSOEVER CAUSED, arising or to arise by reason or my
participation in the said event, whether as spectator, participant, competitor, or otherwise, whether prior to, during
or subsequent to the event, AND NOTWITHSTANDING that same may have been contributed to or occasioned by the
negligence of the aforesaid. I FURTHER HEREBY UNDERTAKE TO HOLD AND SAFE HARMLESS AND AGREE TO
INDEMNIFY all of the aforesaid from and against any and all liability incurred by any or all of them arising as a result
of, or in any way connected with my participation in the said event. Personal information collected is for
registration and results purposes only, and will not be shared with other companies or organizations. Further, I
hereby grant full permission to any and all the foregoing to use any photography, video tapes, motion pictures,
recordings or any other record of this event for promotional purposes.
Pre-Existing Medical Conditions: I do not have any pre-existing medical conditions that would prevent me from
participating safely in this event, or if I do have a pre-existing medical condition, I have checked with my physician
and received their approval to participate.
BY SUBMITTING THIS ENTRY, I ACKNOWLEDGE HAVING READ, UNDERSTOOD, AND AGREE TO THE ABOVE WAIVER,
RELEASE and INDEMITY. I WARRANT that I am physically fit to participate in this event.
All Participants must sign. Participants under 18 years require parent/legal guardian’s name & signature.
First & Last Name: ________________________________________________________________________
Signature: ____________________________________________ Date: ____________________________
MAIL or DROP OFF:
Elora Road Christian School
5696 Wellington Road 7
Guelph, ON N1H 6J2
OR
The Running Works
89 Gordon St.
Guelph, ON N1H 4H6