COLOUR RUN REGISTRATION FORM
Date: May 24, 2025 @10:00AM Registration @9:15AM Park Lake, Neepawa
Name
*
First Name
Last Name
E-mail
*
example@example.com
Contact Number
*
Format: (000) 000-0000.
1KM or 5KM Walk/Run
*
Please Select
1KM
5KM
Age
*
Please Select
Adult 16+
Ages 5-15
Ages 0-4
Additional Entries
Name
First Name
Last Name
1KM or 5KM Walk/Run
Please Select
1KM
5KM
Age
Please Select
Adult 16+
Ages 5-15
Ages 0-4
1KM or 5KM Walk/Run
Please Select
1KM
5KM
Age
Please Select
Age 0-4
Age 5-15
Age 16+
Name
First Name
Last Name
1KM or 5KM Walk/Run
Please Select
1KM
5KM
Age
Please Select
Adult 16+
Ages 5-15
Ages 0-4
Name
First Name
Last Name
1KM or 5KM Walk/Run
Please Select
1KM
5KM
Age
Please Select
Adult 16+
Ages 5-15
Ages 0-4
Cost
Adults - 16+Up - ________x$50
*
5-15Yrs Old ________x$30
*
Ages 0-4 - Free
*
Total :
*
Type of Payment
*
Cheque - (Made out to - Rotary the new wave Neepawa) Mailed to Box 512 Neepawa, MB R0J1H0
E-Transfer - growingrotary@gmail.com
In Case of Emergency
Emergency Contact:
First Name
Last Name
Relationship
Contact Number
Format: (000) 000-0000.
Release and Waiver of Liability - Assumption of Risk and Indemnity Agreement
In consideration of my participation in the Colour Run, I, the undersigned participant, hereby acknowledge and agree to the following:
*
I am fully aware of the risks involved in participating in a Colour Run and voluntarily assume all such risks including colour powder in eyes and mouth. It is recommended to wear sunglasses and/or mouth coverings.
I am physically fit and have no medical conditions that would prevent my participation in the Colour Run.
I agree to comply with all rules and regulations of the Colour Run.
I release, discharge, and hold harmless the organizers of the Colour Run, their officers, directors, employees, volunteers, sponsors, and any other persons or organizations associated with the Colour Run from any and all claims, damages, or injuries, including death, that may arise from my participation in the Colour Run or as a result of my use of any facilities/land or equipment provided by the Colour Run.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit Form
Submit Form
Name
First Name
Last Name
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