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$ZS for Killer Course (close to 5K)
rally towel
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$S tor Filthyfr'ttn Rurt (close to mile)
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Sponsored by Miles City
Star, Wake Up & Lace Up,
with all proceeds
helping cancer
patients and research
New to the course: 18-foot inflatable slide,
inflatable obstacle course! Kids can join in
when not in use!
Register at Miles City Star, Red Rock Sporting
Goods, Holy Rosary, chamber or MCC Centra
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Miles City Mud Run 2013
REGISTRATION FORM
Sunday, Aug. 4,2013, Eastern Montana Fairgrounds, noon-3 p.m.
ALL PARTICIPANTS MUST COMPLETE AND SIGN THE REGISTRATION FORM
AND LIABILITY WAIVER _ PLEASE READ ALL PAGES!
*People may run as teams if they sign up for the same wave or heat, but each
person must complete a form. Costumes/themes are welcome!
9:30-11:30 a.m. - lnflatable slide, obstacle course open for kids ($5 feel
9:30-11:30 a.m. - Race day registration or check-in
12 p.m. - Killer Course (close to 5K) Heat 1
1 p.m.- Filthy Fun Run (close to mile)
1:30 p.m. (approx.) - Killer Course Heat2
Killer Course (close to 5K) - 2 heats available
$25 per lndividual - lncludes rally towel.
Filthy Fun Run or Walk (close to a mile, shorter version of same course)
$5 per individual - towel not included. Open to all ages, but still challenging. lf
child is under 18, parent or legal guardian must sign form.
Make checks payable to: Miles City Star Cancer Fund.
Please complete form and drop it off with payment at the Miles City Star at 818
Main St. or mail it to:
Miles City Mud Run
Miles City Star
P.O. Box 1216
Miles City, MT 59301
FIRST NAME:
LAST NAME:
ADDRESS:
CITY, ST, ZIP:
AGE ON RACE DAY
Phone #
Emergency Contact Name:
PLEASE CIRCLE
ONE:
Killer Course
HeatsMaves for 5K (Circle preference):
Filthy Fun RunAlValk
Noon
DATE
SIGNATURE
(Custodial Parent or Guardian signature if under the age of 18)
1:30 p.m.
For more information, cal! Marla aI234-O450 ext. 1031 or email
mceditor@ m idrivers.com.
Waiver of Liability
Miles City Star Relay Fun Run
ln consideration of my participation in this event, I hereby set forth and agree for myself,
my executors, administrators, heirs, successors, and assigns to be bound by the
following:
ldentification of Risks
a. I understand that participating in any athletic event (the "Event") involves risks
of serious injury; including permanent disability, death, and other losses. I
understand that these injuries and losses might result not only from my actions, but
the actions, inactions, or negligence of others.
b. I acknowledge that participation in this athletic event is an extreme test of a
person's physical and mental limits and carries with it the potential for death,
serious injury and property loss. The risks include, but are not limited to, those
caused by terrain, facilities, temperature, weather, physical condition of athletes,
equipment, and the actions of other people including, but not limited to,
participants, volunteers, spectators, coaches, event officials, motorists and/or producers
of the event.
c. I certify that I am physically fit, have sufficiently trained for participation in the
event and have not been advised otherwise by a qualified medical person.
Assumption of Risks
I agree that I am responsible for my safety while participating in the event and I
assume all risks of participating in this event. I realize that liability may arise from
the actions, inactions, negligence or carelessness on the part of the persons or
entities being released, from dangerous or defective equipment or property owned,
maintained or controlled by them or because of their possible liability without fault.
Waiver
Aware of the risks and willing to assume them, I hereby waive, release, and hold
harmless the Miles City Star, American Cancer Society, City of Miles City, Custer
County, Montana Department of Transportation and any and all participants, volunteers,
producers, coaches, event officials, and others from all claims by me for any liability,
injury, loss or damage in any way connected with my participation in the event, except
where caused by gross negligence or willful or wanton misconduct. I intend for this
waiver and release to also apply to any and all legal action or claim on my behalf.
Authorization for Emergency Care
I hereby consent to receive medical treatment, which may be deemed advisable in
the event of injury, accident and/or illness during this event.
! HAVE READ THIS WAIVER AND RELEASE CAREFULLY AND COMPLETELY,
AND HAVING DONE SO I AM SIGNING IT VOLUNTARILY.
Printed Name
Date
Signature (if pafiicipant is under 18,
include guardian's signature)