Yeshulas Color Run 5K

FUN RUN
5K fun run/walk fundraiser hosted by the Schuylkill Valley Panther Pride
Stadium Campaign, The Schuylkill Valley High School National Honor Society
and Boys Scout Troop 160.
Sunday October 19, 2014 2:00 pm ( Event day registration 1pm)
Registration Form
Name:________________________________________________
Address:______________________________________________
Email:_________________________________________________
Telephone:______________________Age on race day:________
Pre- registration by October10th to guarantee a t-shirt
Entry fee: $20.00 Number of adults_______
Students 12 and under $15. Number of Students_____
Would you like to make an additional donation to Panther Pride Stadium Campaign?
Yes/no amount:______________
T-shirt size (circle one): S M L XL XXL
Make Checks payable to: Panther Pride Stadium Campaign
MAIL to: Tracey Yeshulas
Attention: Color Run
1022 Rick RD
Reading, PA 19605
WAIVER:Iknowthatrunningaroadraceisapotentiallyhazardousactivity.IshouldnotenterandrununlessIammedicallyableandproperlytrained.Ialsoknowthattherewillbe
trafficonthecourseandassumetheriskforrunningintraffic.Ialsoassumeanyorallotherrisksassociatedwithrunningorattendingtheraceincludingbutnotlimitedtofalls,contactwith
otherparticipants,theaffectsoftheweatherandtheconditionoftheroads,allsuchrisksbeingknownandappreciatedbyme.Knowingthesefacts,andinconsiderationofyouraccepting
myentryfee,Iherebyformyself(mychildunder18yearsofageifguardian/parentsigning),myheirs,executors,administratorsoranyoneelsewhomightclaimonmybehalf,covenantnotto
sue,andwaive,releaseanddischargetheSchuylkillValleypantherPrideStadiumCampaign,theSchuylkillValleyNationalHonorsSociety,andtheSchuylkillValleySchoolDistrictand
anysubcontractorsitutilizes,allmunicipalitiesinwhichtheraceisheld,theracecommittee,volunteers,anyandallsponsorsincludingtheiragents,employees,assignsoranyoneacting
forontheirbehalf,oranyoneelseassociatedinanywaywiththerace,fromanyorallclaimsorliabilityfordeath,personalinjuryorpropertydamageofanykindofnaturewhatsoever
arisingoutof,orinthecourseof,myparticipationinthisevent(s).Thiswaiverextendstoallclaimsofeverykindornaturewhatsoever,foreseenorunforeseen,knownorunknown.IHAVE
READANDUNDERSTANDTHISWAIVER:(ifunder18,legalguardianmustsign).IacknowledgethattheSchuylkillValleySchoolDistrictisnotasponsororhostofthisevent,
althoughaportionofthecourseoccursonschooldistrictproperty.
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Signature date / /20____
(ParentsSignatureinsteadifentryisunder18yearsold)
For questions or for more information please email: craftgoober@gmail.com