Rás an Stricín 2022

Rás an Stricín 2022
Áit/ Location: ó Lios Deargáin go barr An Stricín/ Start at Lisdorgan and enjoy the climb to the top of the Stricín

Dáta/ Date: Dé Sathairn 6ú Lúnasa/ Saturday August 6th

Am/ Time: 10.30 rn/ 10.30 am
Sonraí/ Participant Details
Ainm Reathaí/ Runner's Name *

Chéad Ainm/ First Name Sloinne/ Last Name
Inscne/ Gender *

Bain. / Female Fir. /Male
Aois/ Age *

Faoi 16/ Under 16 Os Cionn 16 (€5)/ Over 16 (€5)
Ainm Tuismitheoir (fé 16)/ Parent Name (under 16)

First Name Last Name
Ríomhphost/ Email *
example@example.com
Uimhir/ Phone Number *

Area Code Phone Number
Seoladh/ Address *
e.g. Lios Póil, Annascaul etc..
Duine Éigeandála/ Emergency Contact Person *

First Name Last Name
Uimhir Duine Éigeandála/ Emergency Person Phone Number *

Area Code Phone Number
Tarscaoileadh/ Waiver
*

Aontaím gan páirt a ghlacadh san imeacht seo má tá aon chomhartha do Covid-19 agam (breoite, teocht, casacht, scórnach tinn, tinneas cinn)/ I agree not to partake in this event if I display any symptons of Covid 19 (feeling unwell, fever, cough, sore throat, headache). Ag cur isteach ar an imeacht seo, glacaim freagracht iomlán as aon aicíd, ghortú nó timpiste a d'fhéadadh a tharlú le linn an imeachta/ By submitting this form, I assume full and complete responsibility for any illness, injury or accident, which may occur while participating in this event. Glacaim go bhfuil cead ag na heagraitheoirí aon sonraí pearsanta atá tugtha agam sa bhfoirm seo a úsáid i gcóir eagrucháin an imeachta./ I agree that the organisers have permission to use any personal data provided in this form for the purpose of organising the event.
Participant's Signature *

Clear
Date Signed

Month Day Year
Date
Parent/Guardian Signature (If participant is under 16 years old)

Clear
Íocaíocht Clárúcháin/ Registration Payment
Íoc/ Pay

Beidh €5 agam ag tosach an Ráis chun clárú/ I will bring €5 with me to register at the start of the race
Should be Empty:

Rás an Stricín 2022

Sonraí/ Participant Details

Tarscaoileadh/ Waiver

Íocaíocht Clárúcháin/ Registration Payment