Entry Form

PLEASE PRINT CLEARLY

NAME

Bib#

ADDRESS

CITY

PROV

POSTAL CODE

PHONE

EMAIL

AGE

MALE

FEMALE

Event:

Early Fee

Late Fee

Special Rates

Please check one

Before May 28

After May 28

Youth -

18 and under: early $15 -late $25 – all events

½ Marathon

Run

Walk

$40

$50

Family -

First 2 oldest pay normal rate, rest free.

5 km

Run

Walk

$30

$40

Must live at same address.

Please register all children

Cash or cheque (payable to South Kent Trails)

Waiver, Release and Indemnity

In consideration of  the acceptance of my application and the permission to participate as a participate as an entrant in “Trot To The Beach” half marathon or 5 km event, I, myself, my heirs, executors, administrators, successors and assigns hereby release, waive and forever discharge the Municipality of Chatham Kent, Chatham Kent Trails Council, South Kent Trails, and all the other associations, sanctioning bodies, and sponsoring companies and all their respective agents, officials, servants,  contractors, representatives elected and appointed officials, successors  and assigns of and from all claims, demands, damages, cost, expense, actions and causes of actions, whether in law or equity, in respect of death, injury, loss or damages to my person or property howsoever caused, arising by reason of my participation in the said event, whether as a spectator, participant, competitor, volunteer 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 any of the aforesaid.

I agree to undertake to hold safe and harmless and agree to indemnify all of the aforesaid from and 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 said events.

By submitting this entry I acknowledge having read, understood and agree to the above waiver, release and indemnity, I warrant that I am physically fit to participate in the event.

Date:

Signature:

(Parent or guardian must also sign if under 18)

Mail to:

South Kent Trails

19560 Erieau Road,

Blenheim, Ontario.

N0P 1A0

If you would like to make an additional donation or solicit your friends support, please use this form.

Pledge Form

*Pledges must be collected before the event and turned in on “Trot Day”

Name

Address

Amount

TAX RECIPTS AVAILABLE FOR DONATIONS OVER $20.

REGISTRATION FEE IS WAIVED FOR ENTRIES WITH $50 OR MORE IN PLEADGES