registration form - YMCA Calgary

Sunday, June 3, 2012Time 1K Kids Run | 10:00am5K and 10K Run | 10:20amFees* Adult $35 | Youth (8Y–17Y) $20 | Kids (7Y and under) $5BBQ Only $10Register 1-866-430-9622 or visit any YMCA Calgary location

Family Fun RunDistances1K Kids’ Run5K Run10K RunWhenSunday, June 3Check-in1K Kids’ Run5K/10K RunsWhereHector LodgeCamp Chief Hector YMCAExshaw, Alberta9:00-9:45am10:00am10:20amPledge PackagesPlease hand in completed pledge packageson event day.Other Cool Info• Supervised activities offered for kids 3Y+while you run• Camp Chief Hector YMCA water bottlesgiven to each runner• Medals for all 1K runners• Medals for the fastest male and female in5K and 10K runs• Shower facilities are available. Please bringyour own towels and toiletries.Please note:For a safe run, we request no pets and cautionthat the trail paths are not stroller-friendly.ymcacalgary.orgCamp Chief Hector YMCA’s 5 th Annual Family Fun RunPlease complete this form and return by fax: (403)237-8085, email: cchy@ymcacalgary.org or dropoff to any YMCA Calgary location.Entry FeesAdults $35 | Youth (8Y –17Y) $20 | Kids (7Y and under) $5Optional Pledge PackageRaise a minimum of $100 in pledges for YMCA Strong Kids Campaign and receive a partial refund on yourentry fee. Pledge packages are available online or at any YMCA Calgary location.Yes, please send me a pledge package so I can help support YMCA Strong Kids Campaign.Name(please print clearly)Birthdate(if under 18 Y)Gender(please check one)Race(please check one)Address: _______________________________________________________________________________________Phone: __________________________ Email Address: _________________________________________________Why are you running? ____________________________________________________________________________Is this your first running event? ____________________________________________________________________Payment MethodTotal Amount: $ __________________________Media ReleaseI give my permission for YMCA Calgary to use any photographs, video tapes, or audio tapes that may be taken of me or my family while participatingin the YMCA Calgary Fun Run for promotional or educational purposes (e.g. posters, brochures, ads, etc.). I agree that the photos, video footage and/or audiotape may be used without limitation on time or frequency.Participant Signature: ____________________________________________ Date: _________________________Signature of Parent/Guardian if Participant is under 18: _______________________________________________Liability WaiverIn consideration of your acceptance of this race entry, I for myself, my heirs, executors, administrators and assigns, forever waive, release and dischargeany and all rights, demands, claims for damages and causes of suit or action known or unknown, that I may have against the Camp Chief Hector YMCA,YMCA Calgary and all participating race sponsors, supports, directors, officers, employees, and agents of such parties, for any and all injuries in anymanner arising from my participation in said race, I attest and verify that I have full knowledge of the risks involved in this race, that I assume those risks,that I will assume and pay my own medical and emergency expenses in the event of an accident, illness or other capacity, regardless of whether I haveauthorized such expenses and that I am physically fit and sufficiently trained to participate in this race.Participant Signature: ____________________________________________ Date: __________________________Signature of Parent/Guardian if Participant is under 18: ________________________________________________femalefemalefemalemalemalemaleKids’ Run5K RunKids’ Run5K RunKids’ Run5K RunBBQ Only10K RunBBQ Only10K RunBBQ Only10K RunVISA MasterCard AMEX Cheque (Payable to YMCA Calgary)Credit Card No. ___________________________________________ Expiry Date:________________Signature:__________________________________________________________________________