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CARUSO CLUB FESTIVAL 5KM FUN RUN/WALK July 10, 2005 4PM
REGISTRATION FORM
Last Name ____________________________________________________
First Name ____________________________________________________
Address ______________________________________________________
Sex __________ Age ________ Birth Date: d_____/ m _____/ y______
E-mail address _______________________________________________
Event: 5km Run/Walk _______ 2 km Walk _________
Pre Registration: $8.00 (cheques payable to Caruso Club) Caruso Club 385 Haig St., Sudbury, On P3C 1C5 Registration $10.00 - 3pm – 3:45 pm day of race at the Caruso Club
PRIZES Caruso Club Gift Certificate for winner in each age category ( 5 km event) Chicken & pasta dinner ticket for Sunday July 10th, 2005 for each entrant.
WAIVER
IN CONSIDERATION of the acceptance of my application and the permission to participate as an entrant or competitor in the CARUSO CLUB FESTIVAL 5KM FUN RUN/WALK, I for myself , my heirs, executors, administrators, successors and assigns, HEREBY RELEASE, WAIVE and FOREVER DISCHARGE the following: Caruso Club executive , race organizers, their employees and agents, other race participants, City of Greater Sudbury OF AND FROM ALL claims, demands, damages, costs, expenses, actions and causes of action , whether in law of equity, in respect of death, injury, loss or damage to my person or property HOWSOEVER CAUSED arising or to arise by reason of my participation in Caruso Club Festival 5km Fun Run/Walk, whether prior to, during or subsequent to the event, AND NOTWITHSTANDING that same may have been contributed to or occasioned by, negligence of any of the aforesaid.
I acknowledge that this event has risks (both known and unknown) inherent in it, and it is my intention to accept the risks and all consequences thereof, for myself alone. I am physically fit to participate in this event and have been medically certified to participate.
BY SUBMITTING THIS ENTRY, I ACKNOWLEDGE HAVING READ AND UNDERSTOOD THIS RELEASE AND AGREE TO BE BOUND BY ITS TERMS and I am voluntarily and without duress or influence from anyone.
_____________________________________________ _________________________________ Participant or Parent/Guardian if participant under Date 18 years of age, parent or guardian must sign.
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