pitt community college campus

RACE 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 in the
Bulldog Run on Sunday April 12, 2015, including, but not limited to falls, contacts with other
participants, the effects of the weather, including high heat and/or humidity, low temperature, traffic
and conditions of the road, all risks being known and appreciated by me.
Having read this release and knowing these facts and in consideration of your accepting my
entry, I, for myself and anyone entitled to act in my behalf or on behalf of my estate, waive and
release Pitt Community College, Pitt Community College Foundation, all sponsors of the race,
agents, volunteers, and their successors and assigns of each and every of the above from all claims
or liabilities of any kind arising out of my participation in the race even though the liability may
arise out of negligence or carelessness on the part of the persons referred to in this waiver.
I also grant permission for the use of any photographs, motion pictures, recording, or any other
record of my participation in this event for any legitimate purpose. I understand that if the race is
canceled because of circumstances beyond the control of Pitt Community College, Pitt Community
College Foundation, the race committee, and sponsors, including, but not limited to unsafe weather
conditions or governmental ban, my entry fee will not be refunded.
present the
BULLDOG
RUN
5K & 1 Mile Fun Run
SAFETY NOTICE
For the safety of all the runners and fun run participants, we must prohibit bicycles, roller
skates, roller blades, and all other wheeled vehicles (except wheelchairs) from the Bulldog Run. We
also consider the use of headphones in running events to be a safety hazard, and we advise that
headphones/earbuds be kept at a volume level to where the participant can hear race volunteers.
Pets are not permitted.
By signing below, I agree that I have read and understand
the Race Waiver and Safety Notice.
________________________________________________________
Signature of Participant
Date
If under 18:
_________________________________________________________
Authorization of Parent/Guardian Date
SUNDAY, APRIL 12, 2015 . 4:00 PM
PITT COMMUNITY COLLEGE CAMPUS
BULLDOG
RUN
5K & 1 Mile Fun Run
On Sunday, April 12, 2015 the Pitt Community
College Center for Student Activities is sponsoring a
“Family Fun and Run Day” event to help fund travel,
activities, and pinning ceremonies for student clubs
and organizations. All race participants will receive
FREE baseball tickets for the April 12 doubleheader games beginning at 12 pm, with activities
beginning at 4pm.
PCC Bulldog Run Registration Form
You may also register online @ www.pccbulldogrun.com
Name _________________________________________________________
Address ________________________________________________________
City ____________________________
State _______
Zip _____________
E-mail __________________________
Phone ________________________
Gender:MaleFemale
T-shirt Size: (circle one)
S
Age on Day of Race __________
M
L
XL
XXL
Date of Birth __________________________
Sponsoring Club/Organization
Sunday
April 12, 2015
4:00 pm
Pitt Community College Campus
Lewis Field House
Registration: 4:30 – 6:00 pm
The 1 mile fun run and 5K
will begin at 6:45
Age Categories for Both Sexes
15 & under
16-19
20-29
30-39
40-49
50-59
60-69
70 & over
Prizes will be awarded to the overall
3 Male & Female winners as well as the
top 3 Male & Female winners in each
age group.
All races will run through PCC campus
on flat pavement. Chip scoring will be
provided by Run the East.
Event Entered and Fees: (circle desired race)
5K Road Race
1 Mile Fun Run
$20.00 before April 1, 2015
$________
$25.00 April 1-12 till Race Day
$________
$10.00$________
TOTAL ENCLOSED$________
Check one:
check enclosed - made payable to PCC Foundation: Bulldog Run
credit card (AMEX, MC, VISA) (online registration only)
Card number ___________________________
Signature ______________________________
Mail form and payment to:
PCC Student Act. c/o Katelynn J.
PO Drawer 7007
Greenville, NC 27835
or fax to 252.321.4612
Expiration Date __________