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Registration Form: Sap House Run Waiver Agreement

The document is a registration form for the 2015 Fleischmanns Maple Festival Sap House Run to be held on March 21, 2015. Participants can register on site starting at 8:30am at the Fleischmanns Community Church, and will then be shuttled to the starting line at Vly Creek Maple Farm at 8:45am. The registration fee is $25 if received by March 1st or $30 thereafter, and $10 or $15 for youth. The fees include a t-shirt, maple pancake breakfast, and support the Skene Memorial Library summer children's programs. Participants must sign a waiver releasing the organizers from liability.

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26 views1 page

Registration Form: Sap House Run Waiver Agreement

The document is a registration form for the 2015 Fleischmanns Maple Festival Sap House Run to be held on March 21, 2015. Participants can register on site starting at 8:30am at the Fleischmanns Community Church, and will then be shuttled to the starting line at Vly Creek Maple Farm at 8:45am. The registration fee is $25 if received by March 1st or $30 thereafter, and $10 or $15 for youth. The fees include a t-shirt, maple pancake breakfast, and support the Skene Memorial Library summer children's programs. Participants must sign a waiver releasing the organizers from liability.

Uploaded by

FleischmannsNY
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Registration Form

Saturday, March 21, 2015


Sign-in 8:30am Fleischmanns Community Church 904 Main Street, Fleischmanns
Shuttle to starting line at Vly Creek Maple Farm 8:45am
Name:_________________________

M___ F___ Age:____________

Address:_______________________________Email:__________________________
Phone:__________________________________
Circle:

Run

Walk

T-shirt size (circle one) Youth M

Registration fees includes:


T-Shirt
Maple Pancake Breakfast, before or after Run

Adult S Adult M Adult L

Adult XL

Adult XXL

Adult fee is $25 if received by March 1, $30 thereafter


Youth fee (under 18) is $10 if received by March 1, $15,thereafter

-Net proceeds support the Skene Memorial Library summer childrens programs
The event will take place rain or shine
**All participants must provide a signed waiver
For more information contact Winifred Zubin at [email protected]
To register by mail, send this form and signed waiver to: Make check payable to Mark Project/Fleischmanns First
Fleischmanns First,P.O. Box 111,Fleischmanns, NY 12430, ATTN: Winifred Zubin

Sap House Run Waiver Agreement


I know that walking and running are potentially hazardous activities. I should not enter and run or walk unless I am medically able. I
hereby certify that I am in good health to run or walk the distance of the race, which I am entering. I assume risk associated with
running or walking in this event. I authorize medical treatment by an emergency medical provider. I understand that no accident or
medical insurance is provided and that I am responsible for al medical charges.
Having read this waiver and knowing these facts on my behalf, I waive and release Fleischmanns First volunteers, sponsors, facility
hosts and their representatives from all claims or liabilities of any kind arising out of my participation in this event.
I grant permission to use my photograph or recording of this event for any legitimate purpose.
I give my permission for medical release should I be involved in any accident or health damaging situation or should I require any form
of medical treatment.
2015 Fleischmanns Maple Festival Sap House Run
Print Name:_____________________________________Signature:_________________________________ Date:_________
Age:____Date of Birth:____________ if Minor, Parent/GuardianName:_______________________Signature:_____________________
Relationship to Minor:____________________ Date:________________

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