OSPREY 5K
RUN / WALK
Saturday, May 7, 2011
Event Start Time: 10:00 am. All
participants are to register prior to 9:30 am.
PLEASE PRINT LEGIBLY
Your Name: _______________________________________________ Fee: __$20__
Address:
_______________________________________________________________
_____________________________________________Postal Code: _______________
Phone: __________________ Age: ______ Birth Date: (MM DD YYYY): _____________
E-mail Address: ______________________________ Gender: ( )
Male ( ) Female
Elementary Student: yes / no (please circle) T-shirt Size:
Adult or Youth - S
M L XL (please circle - Sizes not
guaranteed - we'll try!)
Free T-Shirt for the first 100 paid participants. All paid participants
have their name entered for prizes to be drawn at the finish line.
Thank you for supporting the
Riverport and District Community Centre.
I
understand that participating in a foot race is a potentially dangerous
thing. Further, that the weather, footing and vehicular traffic
conditions may be adverse and greatly increase the danger. I certify that
I am medically fit to participate and have sufficiently trained for this event
such to be able to participate without risk to myself. I understand that
I am totally responsible for my own safety at all times and that the providing
of route marshals, police or other traffic control methods in no way removes or
reduces the responsibility from me to ensure my own safety. Therefore, in
consideration of my being permitted to participate as an entrant or competitor
in this event, I for myself, my heirs, executors, administrators, successors
and assigns release, hold harmless, protect and keep indemnified, the race
organizers of the race identified above, Athletics Canada, Athletics Nova
Scotia, Sport Nova Scotia, Run Nova Scotia, any and all clubs, associations,
sanctioning bodies, sponsoring corporations, sponsors, participants, competitors,
entrants, volunteers, and all other agents, officials, servants and
representative from and against any and all actions, claims, costs and
expenses, or demands in respect to death, injury, loss or damage to my person
or property howsoever caused arising out of my participation in, attendance at
or in any way talking part in, prior to or subsequent to the race whether as an
entrant, competitor, participant, or spectator and not withstanding that the
same may have been contributed to or occasioned by the negligence of any of the
aforesaid, their agents, officials, servants or representatives. By my
signature I certify that I have read and understand this document, and intend
to be legally bound by its terms.
Waiver must
be signed to participate in this event.
Signature:
_____________________________________________ Date: _______________
(Parent’s
or guardian’s signature if runner is under 19 years of age)
Event
to take place at Riverport Elementary School, #3176 Hwy 332, Bayport, NS
Cheques
may be made payable to: Riverport and District Community Centre and
mailed to:
Riverport
Elementary School, Attn: Osprey 5k Run/Walk Committee General
Delivery, Riverport, NS B0J 2W0