Document 407644

INAUGURAL MINERAL WELLS PYTHIAN SISTERS
TEMPLE #14 TURKEY TROT FUN RUN
REGISTRATION FORM
Pythian Sisters' use only:
Last Name: ________________________
First Name: ________________________
Assigned bib #: __________________
YOU CAN ALSO FIND THIS FORM ONLINE AT: WWW.MWTURKEYTROT.COM
A SEPARATE REGISTRATION FORM IS REQUIRED FOR EACH PERSON, NO MATTER THEIR AGE.
(Please Print)
Last Name:
First Name:
Mailing Address:
City, State
Zip Code:
Your age (as of 9/1/2014):
Your Phone #:
Your Email:
Emergency Contact:
Name: ________________________________ Phone #: _________________ Relationship: ________________
Fees and the Waiver & Release form must accompany this Registration Form.
Entry fees are non-refundable.
Make checks payable to: Mineral Wells Pythian Sisters Temple #14.
If mailing this form, please mail it to: Mineral Wells Pythian Sisters Temple #14
P.O. Box 842
Mineral Wells TX 76068
Entry fees per participant:
Ages 6 -17
Ages 18+
Teams of 4 or more:
*Children under 6 are Free.
Race day registration - all ages
$ 20.00
$ 25.00
$20.00/each
$35.00
Registration includes t-shirt and race bib, plus a goodie bag of special offers from sponsors and local businesses.
Please indicate t-shirt size below:
Youth:
Small
Medium
Large
XL
Adult:
Small
Medium
Large
XL
2XL
Packet pickup will be the morning of the race, beginning at 7:30 AM. First group starts at 8:00 AM. Pickup
booth will be located at the west end of the Rails to Trails Trailway, just off South Oak Avenue.
PARTICIPANT, OR PARENT/LEGAL GARDIAN OF PARTICIPANT (IF PARTICIPANT IS A MINOR), MUST SIGN THE
WAIVER AND RELEASE FORM ON THE FOLLOWING PAGE. REGISTRATIONS WILL NOT BE ACCEPTED WITHOUT
THE WAIVER SIGNATURE.
Pythian Sisters' use only:
Participant's Last Name: ________________________
WAIVER & RELEASE FORM
Participant's First Name: ________________________
Assigned bib #: __________________
Please initial each line after reading.
______ 1. I understand that participating in the Turkey Trot (“Event”) can be a hazardous activity and will present certain physical and mental
challenges
and I further agree to not participate unless I am medically able.
______ 2. I assume all risks associated with participating in the EVENT, including but not limited to trips, slips, falls, contact with other participants
including children, negligent or wanton acts of other participants, collision with objects or equipment the course, defects or condition of course, the
effects of the weather, including high heat and/or humidity, all such risks being known and appreciated by me.
______ 3.
I agree that the EVENT is not responsible for any personal items that are lost or stolen.
______ 4. I consent to emergency medical care and transportation in order to obtain treatment in the event of injury to me as medical professionals
may
deem appropriate. This release extends to any liability arising out of or in any way connected with the medical treatment and transportation
provided in the event of an emergency.
______ 5.
and
I grant permission to the EVENT, the Mineral Wells Pythian Sisters Temple #14, sponsors, and assign’s to use any photographs, motion pictures,
recordings or any other record of this event for any purpose including but not limited to promoting, advertising and marketing purposes. Any
photographs, motion pictures, recordings or other records of the event are the sole property of the EVENT.
______ 6.
I understand that all entries are final with no refunds even in the event of cancellation of the event.
______ 7. Participants are expected to exhibit appropriate behavior at all times, including obeying all laws. This includes respect for all people,
equipment,
and facilities, and cooperative, positive participation.
______ 8.
I also agree to indemnify the EVENT, its affiliates and assigns, from any and all third party claims caused in whole or in part by my actions.
WAIVER & RELEASE OF ALL CLAIMS & ASSUMPTION OF RISK
The Pythian Sisters Temple #14 is committed to conducting the Event in a safe manner and holds the safety of participants as a priority. However,
participants and parents/guardians of minors registering for the race, programs/activities must recognize there is an inherent risk of injury when
choosing to participate in recreational activities/programs. I am solely responsible for determining if I or my minor child/ward is physically fit and/or
skilled for the race or activities contemplated by this agreement. I recognize and acknowledge that there are certain risks of physical injury to
participants in the Event, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor
child/ward or I may sustain as a result of said participation.
I HEREBY VOLUNTARILY, IRREVOCABLY AND FOREVER RELEASE, INDEMNIFY AND SAVE HARMLESS EVENT, MINERAL WELLS PYTHIAN SISTERS TEMPLE #14, its
officers, the sponsors, owners and/or lessors of any premises, property or piece of equipment used to connection with Event, each of the foregoing
parties' respective affiliates, and each of the foregoing parties' respective current and former owners, partners, members, officers, directors, trustees,
employees, agents, volunteers, officials, representatives, successors, assigns and other participants (collectively, "RELEASEES"). I do hereby fully release
and forever discharge Releasees from any and all claims for injuries, illnesses, damages, expenses, or loss that my minor child/ward or I may have or
may accrue to me or my minor child/ ward and arising out of, connected with, or in any way associated with the Event. I have read and fully
understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. When registering online, my online
signature shall substitute for and have the same legal effect as an original form signature.
I HAVE CAREFULLY READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND THE TERMS, UNDERSTAND THAT I HAVE
GIVEN UP CERTAIN RIGHTS BY AGREEING TO THE TERMS, AND AGREE TO THE TERMS FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I AM AWARE
THAT BY SIGNING THIS WAIVER, RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT OR BY SELECTING THE "I ACCEPT" BUTTON DURING THE ONLINE REGISTRATION PROCESS, I AM AGREEING TO ITS TERMS, INCLUDING WAIVING CERTAIN LEGAL RIGHTS. KNOWING THIS, I AGREE TO THESE TERMS OF MY
OWN FREE WILL.
________________________________
PARTICIPANT PRINTED NAME
________________________________
PARTICIPANT SIGNATURE
___________________
DATE
ONLY COMPLETE BELOW SECTION IF YOU ARE A PARENT OR GUARDIAN OF A PARTICIPANT UNDER THE AGE OF 18:
I, the parent or guardian of the above named participant, hereby give my approval to this child’s participation in the EVENT and its activities. I assume
all risks and hazards incidental to such participation in the event, and I hereby waive, release, absolve, indemnify, and agree to hold harmless the
above named releasees for any claim arising or of an injury to my/our child and from any and all claims for injuries, illnesses, damages, expenses, loss or
responsibilities, of whatsoever kind, nature or description, whether, direct or indirect, in law or in equity, in contract or in tort, or otherwise, whether
known or unknown, from all claims or liabilities of any kind arising out of or connected with my child(ren)’s participation in this event. I consent to the
foregoing and grant permission for him/her to participate in event. I acknowledge I have carefully read, accepted and agreed to the terms on this
release and liability waiver, and know and understand their contents and I sign the same of my own free will.
___________________________________
PARTICIPANT/CHILD'S PRINTED NAME
________________________________
PARENT/GUARDIAN'S SIGNATURE
___________________
DATE
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