PLEASEPRINTCLEARLYANDCOMPLETEALLOFTHEFOLLOWINGINFORMATION: RaceParticipant’sName Mrs._____Mr._____Miss_____email:_______________________________________________________________ FIRST:_______________________________________________LAST:______________________________________________________ Sex(M/F)______AGE(onraceday)________T-ShirtSize(adult)SM________MD________LG________XL________ Address________________________________________________________City______________________________________________________ Province________PostalCode__________________________________Phone#_______________________ PLEASEREADCAREFULLY*RELEASE&WAIVER*AWARENESSOFRISK IacknowledgeandagreethatrunninginaroadraceisapotentiallyhazardousactivityandthatIshouldnotenterandrununlessI ammedicallyableandproperlytrained.Ialsoacknowledgeandagreethatalthoughtraficcontrolwillbeprovidedtherewillbe traficonthecourserouteandaccordinglyIassumetheriskofrunningintrafic.Ialsoassumeanyandallotherrisksassociated withrunningintheRaceincludingbutnotlimitedtoslipsandfalls,contactwithotherparticipants,theeffectsoftheweather, includingrainandhighheatandtheconditionoftheroads,allsuchrisksbeingacknowledgedandappreciatedbyme.Acknowledgingthesefacts,andinconsiderationofyouracceptingmyentry,Iherby,formyself,myheirs,executors,administratorsand anyoneelsewhomightclaimonmybehalf,covenantnottosue,andherebywaive,releaseanddischargeTheCoalCountryRun andallofitssubsidiaries,thecommittee,oficialsandvolunteersworkingontheeventday,RaceSponsors,andotherparticipants intheRaceandalltheiragents,employees,assignsandanyoneelseactingfororontheirbehalf(collectively,the“Indemnities”), fromandagainstanyandallclaimsfordeath,personalinjuryorpropertydamageofanykindornaturewhatsoeverarisingoutof, orinthecourseofmyparticipationinthisRaceotherthanasaresultofthegrossnegligenceoftheIndemnities.ThisReleaseand Waiverextendstoallclaimsofeverykindornaturewhatsoever,foreseenorunforeseen,knownorunknown.Applicationsfor minors(thoseunder18yearsofage)willbeacceptedonlywiththeminor’sandoneofhis/herparents’signatures.Iherbygrant fullpermissiontoTheCoalCountryRuntouseanyphotographs,videotapes,motionpictures,recordings,oranyotherrecordof thisRaceand/orofmeormyminorchildasaparticipantinthisRaceforanylegitimatepurpose.Iherbyacknowledgehavingread thisReleaseandWaiverandbyacceptingaracenumberIunderstandandacceptitstermsandconditions. ____________________________________________________________________________________________________________ SignatureofparticipantDate Signatureofparent/guardian(ifparticipantis18orunder) (PleaserefertoRegistrationInformationforfeestructureanddeadlines) _____Cheque_____Visa_____Mastercard PaymentMethod:Cash IAMENTERING:_____10KRoadRace(timed) _____5KRoadRace(timed) _____5Kor_____10KWalk ____MiniMile WePreferthatyoupaywithCheckorCash,unlessregisteringonline. CardHolder’sName:________________________________Signature______________________________________Expiry:___/___ Walk / Run & “Kids Mini Mile” Proceeds go to 2016 Saskatchewan Summer Games Committee May 9, 2015 Estevan Woodlawn Park __________________________________________________________________________________ AMOUNTPAIDORENCLOSED$_______________________ 10 K — 5 K Start/Finish @ Souris Valley Theatre THREE EASY WAYS TO REGISTER INDIVIDUALFEESFOR5K&10K 1. GoogleRunningroom.com REGULAR -racesinSaskatchewan -racesinMay,2015 (untilApril20) LATE -clickon“CoalCountryRun” $35.00 $50.00 (allentriesafterApril20) 2.Completetheformonbackanddropoffat: -1454NicholsonRd.Estevan -HendersDrugs • 5K&10Kparticipantsunder age16years$20.00 (untilApril20) • 3.Completeandmailyourentryandsigned Coal Country YouthLATEfee$35.00 (allyouthentriesafterApril20) T-Shirtordercutoff—April20th. waverto: Run 2015 May 9 (t-shirtsmaybeavailable-sizechoicenotguaranteed) CoalcountryRun DebbyKnight 1454NicholsonRd. YourFeeGetsYou: Estevan,SKS4A1T8 • CommemorativeT-Shirt(ifregisteredbyApril20) • PostRaceBrunch • RacePkg.withBibNumber&Goodies • DoorPrizes • Achancetowinmedals—top3inishersawardedinyourage&gendercategory: Under1616—30 31—4445-55 Over55 “Kids Mini Mile” Youmustbe15oryoungerparticipateinthe KidsMiniMile Everyparticipantinthe“KidsMiniMile” willreceive; Finisher’sMedal FreeT-Shirt Freelunch DoorPrizeChance
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