Springville Apple Run

Saturday, October 21, 2017

Mail-in Registration Form

First Name:

 

Last  Name:

 

Mailing  Address:

 

City:

 

State:

 

Zip Code:

 

Country:

 

Phone:

Email  Address:

Age on  Race Day:

 

Date of  Birth:

 

Gender:

MALE

FEMALE

Event:

5K RUN

10K Trail RUN

2 Mile Walk

Half Mile Kids Run  (5 -12)

Shirt  Size:

Adult Extra Small

Adult Small

Adult Medium

Adult Large

Adult X-Large

XX (Add $2.00)

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 21, 2017 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 October 7th

By October 14th

Adults

$30

$35

Youth (12 & Under)

$20

$25

Seniors (60 & Over)

$20

$25

 

*** There will be NO Race Day Registration. All Participants must be Pre-Registered by October 14, 2017.

 

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

32011 Ave. 176

Springville, CA  93265

Questions?  Email springvilleapplerun@gmail.com