REGISTRATION FORM
Send to: Blind Ambition Run
120 Cook Dr.
Baldwinsville, NY 13027
Deadline: May 8, 2015
Tee shirts not guaranteed after
that date
Blind runner ___________________________________________________
Name Printed Legibly
Check applicable sight level B1
 Other
 Male
 Female Age ___________ Tee Shirt Size ______________
Address
________________________________________________________
Street
________________________________ ____________ _________
City
State
Zip
______________________________________________
_________________________________________
Phone
E-mail
Guide runner ___________________________________________________
Name Printed Legibly
 Male
 Female Age ___________ Tee Shirt Size _______________
Address
________________________________________________________
Street
________________________________ ____________ _________
City
State
Zip
______________________________________________
_________________________________________
Phone
E-mail
This team will:  Run the course
 Walk the course
Registration fee: The team has the option of paying a registration fee of
$25 or seeking sponsors for a total equal to or greater than the $25
registration fee. Any profit realized will be distributed to Aurora of CNY and
for local Lions Club Community Services. WSE encourage runners to seek
sponsors at the $20 level.
Rules:
1. All visitors and runners must comply with the park rules.
2. Route will not be closed to the public. Guide runners must ensure the blind
runner is aware of bicyclists or roller blade users on the course.
3. Each team shall consist of one blind or blind folded runner and one sighted
runner tethered together.
4. Tethers shall be no longer than 30”.
5. Footwear is strictly at the discretion of the runner.
6. All guide runners to be sighted humans. Guide dogs are welcome at the event
but not permitted to run the race course.
7. Each team must be tethered together.
8. Tethers shall be of a design by the team.
9. Other than B1 certified runners, “blind” runners are to be blindfolded.
10. A sighted runner can act as the blind runner through use of a blindfold.
11. Teams will be provided a blindfold by the race promoter. No other blindfolds are
permitted. B1 runners must provide certification to waive blind fold.
12. Blind runner must cross the finish line ahead of the guide runner.
13. No pushing or pulling permitted.
14. Guide runners must be on foot – skates, skateboards, bicycles, unicycles or
other form of wheeled devices are not permitted.
15. Verbal instructions between blind runner and their own guide runner is permitted
and encouraged.
16. Distance between team members should not exceed 19”.
17. Blind runner will be the timed team member wearing the race bib.
18. Any blind or guide runner or participant in any of the events under the age of 18
on the date of the event must be accompanied by a parent or legal guardian.
19. Event cancellation: The event will be run rain or shine. However, in the occasion
of lightning immediately prior to or at the start time, the run will be delayed until
30 minutes after the last clap of thunder. Park staff shall determine if delay has
been too long and will determine if the run is to be cancelled due to the delay.
I have read the rules above and understand that I am running in this event solely
at my own risk. I grant permission for the Baldwinsville and Phoenix Lions Clubs
to use any photographs, motion pictures, recordings or any other record of this
event for legitimate purposes.
Blind runner _____________________________________ __________________,2015
Signature
Date
_____________________________________
__________________,2015
Guide Runner ___________________________________
__________________, 2015
Parent’s Signature if Runner is under the age of 18
Signature
Date
Date
____________________________________ __________________,2015
Parent’s Signature if Guide Runner is under the age of 18
Date
Do Not Write Below This Line
Date Received ____________, 2015
Bib number _______________________
RUNNER’S SPONSOR LIST
May 31, 2015 Blind Ambition Team Run
Please collect all sponsor donations before
the event. Please make checks payable to
“Baldwinsville Lions Club”
Runner __________________________________________________________________
Sponsor’s Name _________________________________________________________
Sponsor’s Address ______________________________________________________
Amount $______
______________________________________________________
Sponsor’s Name _________________________________________________________
Sponsor’s Address ______________________________________________________
Amount $______
______________________________________________________
Sponsor’s Name _________________________________________________________
Sponsor’s Address ______________________________________________________
Amount $______
______________________________________________________
Sponsor’s Name _________________________________________________________
Sponsor’s Address ______________________________________________________
Amount $______
______________________________________________________
Sponsor’s Name _________________________________________________________
Sponsor’s Address _______________________________________________________
Amount $______
_______________________________________________________
Sheet total $_____________