entry form - Carrollwood Day School
ENTRY FORM Thank you for sponsoring the Ninth Annual Patriot Run &Walk, Saturday, October 14, 2017. The event includes: ● ● ● ●
5K Run and Walk (all ages): Co-Ed Sprint Relay (adults): One-Mile Riot Run (all ages): Children’s Races (ages 2-11):
Awards to top finishers in several age categories A fun parent vs faculty/staff event All children receive a medal All children receive a medal
Go to http://budurl.com/PatriotRun for complete information and registration. All participants who REGISTER by OCTOBER 2, 2017 will receive a t-shirt! The t-shirt order will be placed on that day. All students who participate in the Patriot Run will have a special free dress day in school! Participants are still welcome and encouraged to register up until event day, however, t-shirts will not be available.
ENTRY INFORMATION EVENT FEES: $35 Adults | $30 Students ** Allows you to participate in all races** Name
E-mail
Address Age:
City
State
Zip
! One Mile Fun Run
! Kids Race
If student, grade: ________ ! 5K
Events you would like to participate in: Shirt Size: Youth:
6/8
Adult:
S
10/12 M
14/16 L
XL
XXL
**Each participant must submit an Entry Form. If you have multiple entry forms for your family, submit all forms together with total payment information on any one of the forms.** To pay by credit card, register online at http://budurl.com/PatriotRun Entry forms can be faxed to 813.920.8237 or delivered to front desk at either the Bearss Avenue Campus or ECC. Please send check payable to CDS and reservation form to: Carrollwood Day School | 1515 W. Bearss Avenue | Tampa, FL 33613 ! Yes, I will utilize the on-field childcare. [For 5k only / CDS families, only] ____ # of children ! No, I will not need childcare
This release is a contract with legal and binding consequences and it applies to all races and activities entered at the event. In consideration of the acceptance of my application for entry in the above event(s), I hereby freely agree to and make the following contractual representations and warranties. I acknowledge that: (i) running/walking is a potentially hazardous activity; (ii) I should not enter and run or walk unless I am medically able and properly trained; (iii) I hereby certify that I am in good health and I have trained to run or walk the distance of the race which I am entering; (iv) I fully assume all risks associated with running/walking this event including, but not limited to: falls, contact with other participants, the effects of weather, including high heat and/or humidity, my own or others’ negligence, and conditions of the course, all risks being known, acknowledged and appreciated by me. Having read this waiver and knowing these facts, I, for myself and anyone entitled to act on my behalf, hereby waive, release, discharge, hold harmless and promise not to sue Carrollwood Day School Education, Inc., its officers, directors, agents, volunteers and employees, all sponsors, their representatives and successors (collectively, the “Releasees”), from any and all claims or liabilities of any kind I may allege against the Releasees as a direct or indirect result of injuries arising out of my participation in this event. Participant print name:
Date:
Age:
Participant signature: Consent and Release of Parent or Guardian for person under eighteen (18) years of age I am the parent or guardian of . My child is fit for the event and I consent to my child’s participation. I have read and understand the above contract/entry form. In consideration of allowing my child to participate, I consent to the contract/entry form and agree that its terms shall likewise bind me, my child and our heirs, legal representatives and assignees. I hereby waive, release, discharge, hold harmless and promise no to sue the Releasees from any and all claims or liabilities of any kind that I or my child may allege against the Releasees as a direct or indirect result of injuries to my child arising out of my child’s participation in the event. Signature of Parent or Guardian
5K Run and Walk (all ages): Co-Ed Sprint Relay (adults): One-Mile Riot Run (all ages): Children’s Races (ages 2-11):
Awards to top finishers in several age categories A fun parent vs faculty/staff event All children receive a medal All children receive a medal
Go to http://budurl.com/PatriotRun for complete information and registration. All participants who REGISTER by OCTOBER 2, 2017 will receive a t-shirt! The t-shirt order will be placed on that day. All students who participate in the Patriot Run will have a special free dress day in school! Participants are still welcome and encouraged to register up until event day, however, t-shirts will not be available.
ENTRY INFORMATION EVENT FEES: $35 Adults | $30 Students ** Allows you to participate in all races** Name
Address Age:
City
State
Zip
! One Mile Fun Run
! Kids Race
If student, grade: ________ ! 5K
Events you would like to participate in: Shirt Size: Youth:
6/8
Adult:
S
10/12 M
14/16 L
XL
XXL
**Each participant must submit an Entry Form. If you have multiple entry forms for your family, submit all forms together with total payment information on any one of the forms.** To pay by credit card, register online at http://budurl.com/PatriotRun Entry forms can be faxed to 813.920.8237 or delivered to front desk at either the Bearss Avenue Campus or ECC. Please send check payable to CDS and reservation form to: Carrollwood Day School | 1515 W. Bearss Avenue | Tampa, FL 33613 ! Yes, I will utilize the on-field childcare. [For 5k only / CDS families, only] ____ # of children ! No, I will not need childcare
This release is a contract with legal and binding consequences and it applies to all races and activities entered at the event. In consideration of the acceptance of my application for entry in the above event(s), I hereby freely agree to and make the following contractual representations and warranties. I acknowledge that: (i) running/walking is a potentially hazardous activity; (ii) I should not enter and run or walk unless I am medically able and properly trained; (iii) I hereby certify that I am in good health and I have trained to run or walk the distance of the race which I am entering; (iv) I fully assume all risks associated with running/walking this event including, but not limited to: falls, contact with other participants, the effects of weather, including high heat and/or humidity, my own or others’ negligence, and conditions of the course, all risks being known, acknowledged and appreciated by me. Having read this waiver and knowing these facts, I, for myself and anyone entitled to act on my behalf, hereby waive, release, discharge, hold harmless and promise not to sue Carrollwood Day School Education, Inc., its officers, directors, agents, volunteers and employees, all sponsors, their representatives and successors (collectively, the “Releasees”), from any and all claims or liabilities of any kind I may allege against the Releasees as a direct or indirect result of injuries arising out of my participation in this event. Participant print name:
Date:
Age:
Participant signature: Consent and Release of Parent or Guardian for person under eighteen (18) years of age I am the parent or guardian of . My child is fit for the event and I consent to my child’s participation. I have read and understand the above contract/entry form. In consideration of allowing my child to participate, I consent to the contract/entry form and agree that its terms shall likewise bind me, my child and our heirs, legal representatives and assignees. I hereby waive, release, discharge, hold harmless and promise no to sue the Releasees from any and all claims or liabilities of any kind that I or my child may allege against the Releasees as a direct or indirect result of injuries to my child arising out of my child’s participation in the event. Signature of Parent or Guardian
