Valley Fun Color Run Sunday, August 20 @ Minnedosa Ag Grounds

Entry type: Individual Team/Family

Team name (if applicable): ______________________________________________________________

First Name: _________________________________ Last Name: _______________________________

Gender: Female Male DOB (dd/mm/yyyy): __________/__________/__________

Email: _____________________________________________ Phone: ___________________________

Mailing Address: ______________________________________________________________________

People running with you (name & age):

Name: _____________________________________________________ Age: ________________

Name: _____________________________________________________ Age: ________________

Name: _____________________________________________________ Age: ________________

Name: _____________________________________________________ Age: ________________

Emergency Contact: __________________________________________________________________

The 2017 Color Run is co-presented by the Minnedosa

Rotary Club, Minnedosa Lions Club and Minnedosa Beach

Enhancement Committee.

Please make cheques payable to: VALLEY FUN COLOR RUN

Send forms with payment to: Minnedosa Recreation Commission

39c Main Street S

Box 1259 Minnedosa, MB R0J 1E0

Registration Fees: ___________ Adult x $40

___________ Student (10-16) x $20

___________ Youth (6-9) x $10

___________ Child (5 and under) FREE

___________ Family x $100 Two adults, two children

___________ Business x $125 Team of four adults

TOTAL: __________________

Elements of Risk: The Valley Fun Color Run can involve certain elements of risk. Injuries may occur while participating in these

activities. Following are examples of the types of injury which may result from participating in the above activity. There may also be

risk of other types of injury.

1. Broken bones ex: arm, leg, finger

2. Spinal Injuries

3. Cuts, bruises and sprains

3. Other

The risk of sustaining injuries results from the nature of the activity and can occur without fault of the child, or the Valley Fun Color

Run, its employees/agents or the facility where the activity is taking place. By choosing to have you or your child take part in this

activity, you are accepting the risk that you or your child may be injured. The chance of an injury occurring can be reduced by

carefully following instructions at all times while engaged in the activity. If you choose to or choose to have your child participate in

the above described activity, you must understand that you bear responsibility for any injury that might occur. The Valley Fun

Color Run does not provide accidental death, dismemberment or medical insurance on behalf of the people participating in this

activity.

Acknowledgement: I HAVE READ THE ABOVE. I UNDERSTAND THAT IN PARTICIPATING IN THE ACTIVITY DESCRIBED

ABOVE, I AM ASSUMING THE RISKS ASSOCIATED WITH DOING SO.

If under 18 years of age:

I give ________________________________________ permission to participate in the Valley Fun Color Run. Child’s Name

Name of Parent/Guardian (Print): ___________________________________________________

Parent/Guardian Signature: ________________________ _____________

Date: ________________________________

Valley Fun Color Run Sunday, August 20, 2017 - Minnedosa Ag Grounds

If over 18 years of age: I ________________________________________ understand the risks associated and agree to participate in

the Valley Fun Color Run.

Signature: ________________________ ____

Date: ________________________________