Springville Apple Run
Saturday, October 20, 2012
8:00 am Kids Run
8:30 am 5K/10K/2M
Printable Registration Form
| First Name: | |
| Last Name: | |
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| Phone: | |
| Email Address: | @ |
| Age on Race Day: | |
| Date of Birth: | // |
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Full Waiver & Release
In consideration for my entry being accepted, I hereby waive and release
forever for myself and for my heirs, executors, administrators, any and all
claims, causes of actions and suits I may accrue against the Springville
Community Club, Springville, County of
Tulare, property owners on
whose property the race is run, race director, race volunteers and any
sponsors of this race for any bodily injury, emotional injury, property
damage or economic loss, including death, suffered by me while traveling to
and from or competing in the Springville Apple Run 5K Run, 10K Trail Run, 2
Mile Walk or Half Mile Kids Run
on October 20, 2012 whether from natural hazards, human-made hazards, actions or
inactions of third parties, or any other
defect or omission or act.
| I accept the full waiver and release. | |
| I accept on behalf of the below-named minor and represent that I have the authority to sign this release. |
| Signature: |
| Name of Minor: |
| Fees: |
By September 30th |
By October 14th |
Adults |
$24 |
$30 |
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Youth (12 & Under) |
$19 |
$25 |
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Seniors (60 & Over) |
$19 |
$25 |
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*** There will be NO Race Day Registration. All Participants must be Pre-Registered by October 14, 2012. |
| Amount Enclosed: |
Please make check payable to: Springville Community Club
No Refunds - all payments are a donation to the Springville Community Club
Please mail registration form and check to:
Springville Apple Run
PO Box 912
Springville, CA 93265
Questions? Email applerun@ocsnet.net