Cimarron HALOS
5K Run/Walk
Sunday, October 1, 2017
8:00 AM
Philmont Scout Ranch
Cimarron, NM
Registration: Sept 7th - Oct 1st
$20/person
Cimarron Students Free
Register early to guarantee your t-shirt
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Registration may be made in person or by mail. Payment must be by check or cash only at the Cimarron Elementary Middle School Attn: HALOS C/O Celina Cortez 132 N Collison Ave, Cimarron, NM 87714; Phone: 575-376-2445. Checks made payable to HALOS. Waiver must accompany registration.
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INDIVIDUAL
Participant: Gender:(circleone) Male Female Age: Address:
City: StateZip
Email: Phone: Circleone: Runner Walker
CIMARRON HALOS 5K RUN/WALK
RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT
EVENT DESCRIPTION: Cimarron HALOS 5k Run/Walk is a 5 kilometer (3.2 mile) off-road running event to be held on Sunday October 1, 2017 beginning and ending at Philmont Scout Ranch, Cimarron, NM 87714.
THE UNDERSIGNED ACKNOWLEDGES AND UNDERSTANDS THAT:
- Cimarron HALOS 5k Run/Walk involves trail running an activity which may include risks such as, but not limited to, falls, interactions with other participants, and effects of weather, traffic and conditions of the road and trail.
- It is his/her responsibility to dress appropriately; and that
- He/she is solely responsible for his/her own health and safety.
Theundersignedunderstandsandexpressly assumesallrisks,includingpersonalinjuryanddeath,arisinginanywayoutofhis/ her participation in the Cimarron HALOS 5k Run/Walk to be held on Sunday October 1st, beginning and ending at Philmont Scout Ranch Cimarron, NM 87714and/orrelated activities.Inadditiontheundersignedrepresentsandwarrantsthathe/sheisphysicallyfitandabletoparticipateintheCimarron HALOS 5k Run/Walkandtheundersignedexpresslyagreestostopandrequestassistanceifhe/sheexperiencesany symptomssuchas,butnotlimitedto,dizziness,excessivefatigue,shortnessofbreath,painoranyotherconditionswhichwould make it difficult or unsafe tocontinue.
IN CONSIDERATION FOR BEING PERMITTED TO ENTER AND PARTICIPATE IN THE CIMARRON HALOS 5K RUN/WALK THE UNDERSIGNED AGREES
forhim/herself,his/herheirs,executorsandadministrators,nottosue,andtodischarge,release,indemnifyandholdthePhilmont Scout Ranch,Cimarron Municipal Schoolstheiraffiliates,officers,directors,volunteersandemployees,andallsponsoringbusinessesandorganizationsandtheiragentsandemployees,fromanyand all liability, claims, demands, and causes of action whatsoever, arising out of the undersigned participation in Cimarron HALOS 5k Run/Walkand/or related activities - whether it results from the negligence of any of the above or from any othercause.Thisrelease,waiverofliabilityandindemnificationagreementshallbeasbroadandinclusiveasispermittedbythe lawsoftheStateofNewMexico.Ifanyportionthisagreementisheldinvalid,thebalanceshallcontinueinfullforceandeffect.
THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS TH IS RELEASE, WAIVER OF LIABILITY AND INDEM NITY AGREEMENT AND FURTHER AGREES THAT NO ORAL REPRESENTATIONS, STATEMENTS, OR INDUCE MENTS APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE.
The Undersigned hereby represents that he /she is at least eighteen (18) years of age
NameofParticipant(pleaseprint):_ Signature ofParticipant:
Date:
If the Participantisunder18theParticipant'sparentorlegalguardianmustsign.
IamthelegalguardianofParticipant,andIherebyconsenttohis/herparticipation.I havereadtheforegoingreleaseandindemnificationagreement,andIherebyagreeonbehalfofmyselfandParticipanttoitsterms.
NameofParentorLegalGuardian (pleaseprint):_ SignatureofLegalGuardianoftheParticipant: _ Date: ______