Monday, May 25, 2015 Registration: 7:20 AM – 8:20 AM Start Time: 8:30 AM PROMPT! Law Park Pavilion 1 Library Rd., Briarcliff Manor, NY 10510 The heart of our Village is community. The Friends of the Briarcliff Manor Public Library raises funds for our Library while encouraging community awareness of the Library as a cultural resource through sponsorship of educational events and programs. All proceeds from this event benefit the Briarcliff Manor Public Library. STOP! Save paper and money! Register online at http://bmplfriends.org/register.html through May 21, 2015. Name_______________________________________________________________________ Age ______ M/F ______ Street_____________________________City________________________ State______ Ph______________________ Email ____________________________________ Emergency Contact _______________________________________ I am doing the: _____ 5K Run _____ 2 Mile Walk > Runners, enter your date of birth: ___________________ This is a chip-timed race! ____$30 Adult ____$20 Child (12 and under) Registration *before* May 18, 2015 is only $25/adult and $15/child. The first 300 registrants will receive a 2015 race t-shirt. Visit facebook.com/bmplfriends for the most up-to-date race information, including the day of the race. Pre-registration must be postmarked by May 18, 2015. Make checks payable to: FOBMPL/Memorial Day Run. Mail registration to: FOBMPL, P.O. Box 205, Briarcliff Manor, NY, 10510. Waiver & Release In consideration for being permitted to participate in the Friends of the Briarcliff Manor Public Library Memorial Day 5K Run/Walk, benefitting the Friends of Briarcliff Manor Public Library, the Undersigned: 1. Hereby covenants not to sue, releases, waives and discharges the Friends of Briarcliff Manor Public Library, or any of their related companies, subsidiaries or affiliates, or their officers, directors, management, officials, employees, volunteers or any grounds operators, ground owners, promoters, sponsors, advertisers, owners and lessees of premises used to conduct the Memorial Day 5K Run/Walk (hereinafter identified as “the event”) and each of them their officers and employees, (all for the purpose herein referred to as “releasees”), from all liability to the undersigned, his/her personal representatives, assignees, heirs and next of kin for any and all loss or damage, any claim or demands therefore on account of injury to the person or property or resulting in the death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is participating in the event. 2. Hereby agrees to indemnify and save and hold harmless the releasees and each of them from any loss, liability, damage or cost (including attorneys fees) they may incur due to the presence of the undersigned participating in the event and whether caused by the negligence of the releasees or otherwise. 3. Hereby assumes full responsibility for, and risk of, bodily injury, death or property damage due to the negligence of releasees or otherwise while participating in the event. The undersigned expressly acknowledges and agrees that the activities of the event may be dangerous and involve risk of injury, serious injury and/or property damage. The undersigned further expressly agrees that the foregoing release, waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by laws of the state of New York and that if any portion hereof is held invalid, it is agreed that the balance shall notwithstanding, continue in full legal forces and effect. 4. The undersigned has read and voluntarily signs this release and waiver of liability and indemnity agreement, and further agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made. 5. The undersigned also agrees to the use of any photos, slides, video tapes, etc. that might contain the likeness of the undersigned, for use in promotional and/or informational activities as deemed appropriate by any of the releasees. Signature________________________________________________________________ Date ______________________________ sponsored by Parent or guardian signature required for participants under age 18. Use a separate form for each participant. We must have a signed waiver for each participant. For more information, got to http://facebook.com/bmplfriends or http://bmplfriends.org. bmplfriends.org
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