Cass District Library Super Fun Color Run Registration Form Please use a separate form for each participant. Date: Saturday, June 6, 2015 Location: Outdoor Track at Cass County Council On Aging (60525 Decatur Rd., Cassopolis, MI 49031) Time: Run/Walk begins at 9:00 am Registration Fee: Free Registration Deadline: Registrations will be accepted at the Main Library (319 M 62, Cassopolis, MI) through Friday, June 5, 2015. Registrations will also be accepted onsite at the event from 8:15-8:45 am on Saturday, June 6. Name: __________________________________________________________________________________ Age: ___________ Address: ________________________________________________________________________________________________ City: _______________________________________________ State: _____________________ Zip: ____________________ Phone Number: _________________________________ Email: __________________________________________________ T-shirt Purchase Registration Deadline: Saturday, May 23, 2015 The run is free and it is optional to purchase a t-shirt. If you would like a t-shirt there is a $9.00 charge for each t-shirt that you order. Checks can be made payable to Cass District Library. Payment is due with your registration by Saturday, May 23, 2015. Pick up your shirt at the check-in table between 8:15-8:45 am on June 6, at the Super Fun Color Run. If ordering a t-shirt please circle the size below: Youth: S M L Adult: S M L XL XXL Waiver of Liability for the Cass District Library Super Fun Color Run—06/06/15 I understand and agree that participating in the Cass District Library Super Fun Color Run is a voluntary undertaking. I understand and agree that by participating in this event I am voluntarily assuming the risk of physical injury and death. I agree to waive and release any and all claims I may incur against the Cass District Library, Cass County Council on Aging, all of their employees and volunteers, along with any and all officials and sponsors of this run, and their successors, and representatives, for any and all damages, or other liabilities suffered by me which might result from my voluntary participation in this run. This waiver and release shall be binding upon me and upon my executors, administrators, personal representatives, heirs, successors and assigns. I agree to comply with all the rules and regulations and event instructors for my own safety and the safety of other participants . Signature of Participant: ______________________________________________ Date: ________________________ Parent/Guardian waiver and release for minor: Signature of Parent/Guardian: __________________________________________ Date: ________________________ Details: This Super Fun Color Run will kick off our Summer Reading Club program that begins Monday, June 8. We welcome individuals and families to participate. This fun run has been created by the Cass District Library’s Teen Advisory Group. There will be stations throughout the track where paint or powdered color will be thrown towards the participants. Please wear clothing that you don’t mind getting covered with color! All minors need a parent/guardian's permission to participate. All minors under age 13 must be accompanied by an adult at the event to participate in the run/walk. For more information call: Stephanie Knepple at 269-445-3400 ext. 34 http://cass.lib.mi.us Please return registration form to the attention of Stephanie Knepple via: Cass District Library, Attn: Stephanie Knepple, 319 M 62, Cassopolis, MI 49031 PLEASE AVOID GOING INTO THE CASS COUNTY COUNCIL ON AGING BUILDING ON THE DAY OF THE RUN! THERE IS A PORT-A-JOHN AVAILABLE TO USE NEAR THE TRACK. THANK YOU!
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