Sunday June 7, 2015 Registration Form All entries are non-refundable and non-transferable. Instructions: This PDF form can be ﬁlled digitally on Computer and printed and signed or printed and ﬁll by hand and signed. Choose An Event: After April 30th, 2015 15km Road Race $50.00 $60.00 5km Road Race $50.00 $60.00 1km Family Fun Race $10.00 $15.00 $5.00 Pancake Breakfast Supporting Easter Seals Foundation $5.00 Bread and Honey Festival Ticket Donation To Our Charities: Trillium Health Partners Foundation & Peel Caring Network for Challenged Kids. Amount $: 1. Fill out registration form and sign. 2. Enclose a cheque payable to the: Credit Valley Marathon Club 3. Mail to: Credit Valley Marathon Club 3837 Oland Drive Mississauga, ON Your Information: L5M 6M8 Last Name: First Name: Address: City: Province: Postal Code: Day Phone: Email: Permission to contact via email Date Of Birth: Year _ _ _ _ Age On Race Day: _ _ _ Month _ _ Gender: Day _ _ Male Female WAIVER Release, Waiver and Indemnity: IN CONSIDERATION of the acceptance of my application and the permission to participate as an entrant to compete in the Bread and Honey 1km / 5km / 15km Family Fun Runs to be held on June 7, 2015, I, for myself, my heirs, executors, administrators, successors and assigns, HEREBY RELEASE, WAIVE, AND FOREVER DISCHARGE The Corporation of the City of Mississauga, in Regional Municipality of Peel, the Peel Board of Education the Peel Regional Police, The Credit Valley Marathon Club, the Ontario Track and Field Association, the Ontario Roadrunners Association, the Bread and Honey Festival organizers, CARING NETWORK FOR CHALLENGED KIDS, Timex Canada and all other associations, sanctioning bodies and sponsoring companies, and all their respective agents, ofﬁcials, successors and assigns OF AND FROM ALL CLAIMS, demands, damages, costs, expenses, actions and causes of action, whether in law or in equity, in respect of death, loss or damage to person or property HOWSOEVER CAUSED, arising or to the event and NOTWITHSTANDING that same may have been contributed to or occasioned by the negligence of any of the foresaid, I FURTHER HEREBY UNDERTAKE to HOLD AND SAVE HARMLESS and AGREE TO INDEMNIFY all of the foresaid from and against any and all liability incurred by any and all of them arising as a result of, or in any way connected with my participation in the said event. By SUBMITTING this ENTRY, I ACKNOWLEDGE HAVING READ, UNDERSTOOD AND AGREE to the above WAIVER, RELEASE and INDEMNIFY. I WARRANT that I am physically ﬁt to participate in this event. Tick this box to agree to the WAIVER. Signature/Guardian: Date: