ENTRY FORM FOR THE DON FARQUHARSON HARRIERS RELAY CHAMPIONSHIP

If this is an individual entry (or you are the contact person for the team), please complete 'Section A'. If a team entry, then all three team members' names must be entered in 'Section B' in the order in which they intend to run. Please print and don't forget to sign the waiver at the bottom of the entry form on which provision is made for both individuals and teams to sign.

Please check box applicable - Is this a team entry? Is this an individual entry?

Section 'A' (Individual):

Last name___________________________________________________________ First name__________________________

Street Address______________________________________________________________Phone No.____________________

Town____________________________________________ Province_____________________ Postal Code_______________

Club (if any)________________________________ ____________________ Age on October 22, 2006 ________ M/F_______

 

Section 'B' (Team):

Names of Team Members Age M/F

Runner #1 _______________________________________________________________________ _____ _____

Runner #2 _______________________________________________________________________ _____ _____

Runner #3 _______________________________________________________________________ _____ _____

I enclose: $15.00 individual or $45.00 team

Mail entry (make cheques payable to C.M.A.A.) to: Jack Castle, "Don Farquharson Harriers Relay Championship",

303-123 Bellamy Road North, Scarborough, Ontario, M1J 2K9

to be received no later than noon, Wednesday, October 18, 2006.

Release, Waiver and Indemnity

In consideration of the acceptance of my application to participate as an entrant in the Don Farquharson Harriers Relay Championship, I for myself, my heirs, executors, administrators, successors and assigns hereby waive and forever discharge the City of Toronto, Canadian Masters Athletic Association, Brooks Canada, the Meet Director, all Meet Officials and any and all of their agents of and from all claims demands, damages, costs, expenses, actions and causes of action, whether in law or in equity, in respect of death, injury, loss or damage to my person or property howsoever caused, arising to or to arise by reason of my participation in the said event, whether as spectator, participant, competitor, or otherwise whether prior to, during or subsequent to the event and notwithstanding that same may have been contributed to or occasioned by the negligence of the aforesaid. I further hereby undertake to hold and save harmless and agree to indemnify all of the aforesaid from or against any and all liability incurred by any or all of them arising as a result of, or in any way connected with my participation in the Don Farquharson Harriers Relay Championship. In submitting this entry, I acknowledge that I have understood and agreed to the above waiver, and I warrant that I am physically fit to participate in the event.

Individual:

Please print name here____________________________________________ Signature__________________________

Date_____________________________

Team:

Runner #1 please print name here___________________________________ Signature__________________________

Runner #2 please print name here___________________________________ Signature__________________________

Runner #3 please print name here___________________________________ Signature__________________________

 

Date ______________________________