CDL 2015 Color Run Registration Form

Cass District Library
Super Fun Color Run Registration Form
Please use a separate form for each participant.
Date: Saturday, June 6, 2015
Location: Outdoor Track at Cass County Council On Aging (60525 Decatur Rd., Cassopolis, MI 49031)
Time: Run/Walk begins at 9:00 am
Registration Fee: Free
Registration Deadline: Registrations will be accepted at the Main Library (319 M 62, Cassopolis, MI) through Friday, June 5, 2015.
Registrations will also be accepted onsite at the event from 8:15-8:45 am on Saturday, June 6.
Name: __________________________________________________________________________________ Age: ___________
Address: ________________________________________________________________________________________________
City: _______________________________________________ State: _____________________ Zip: ____________________
Phone Number: _________________________________ Email: __________________________________________________
T-shirt Purchase Registration Deadline: Saturday, May 23, 2015
The run is free and it is optional to purchase a t-shirt. If you would like a t-shirt there is a $9.00 charge for each t-shirt that you order.
Checks can be made payable to Cass District Library. Payment is due with your registration by Saturday, May 23, 2015. Pick up your shirt at
the check-in table between 8:15-8:45 am on June 6, at the Super Fun Color Run.
If ordering a t-shirt please circle the size below:
Youth: S
M
L
Adult: S
M
L
XL
XXL
Waiver of Liability for the Cass District Library Super Fun Color Run—06/06/15
I understand and agree that participating in the Cass District Library Super Fun Color Run is a voluntary undertaking. I understand and agree
that by participating in this event I am voluntarily assuming the risk of physical injury and death. I agree to waive and release any and all
claims I may incur against the Cass District Library, Cass County Council on Aging, all of their employees and volunteers, along with any and
all officials and sponsors of this run, and their successors, and representatives, for any and all damages, or other liabilities suffered by me
which might result from my voluntary participation in this run. This waiver and release shall be binding upon me and upon my executors,
administrators, personal representatives, heirs, successors and assigns. I agree to comply with all the rules and regulations and
event instructors for my own safety and the safety of other participants .
Signature of Participant: ______________________________________________
Date: ________________________
Parent/Guardian waiver and release for minor:
Signature of Parent/Guardian: __________________________________________
Date: ________________________
Details:
This Super Fun Color Run will kick off our Summer Reading Club program that begins Monday, June 8. We welcome individuals and families
to participate. This fun run has been created by the Cass District Library’s Teen Advisory Group. There will be stations throughout the track
where paint or powdered color will be thrown towards the participants. Please wear clothing that you don’t mind getting covered with
color! All minors need a parent/guardian's permission to participate. All minors under age 13 must be accompanied by an adult at the
event to participate in the run/walk. For more information call: Stephanie Knepple at 269-445-3400 ext. 34
http://cass.lib.mi.us
Please return registration form to the attention of Stephanie Knepple via:
Cass District Library, Attn: Stephanie Knepple, 319 M 62, Cassopolis, MI 49031
PLEASE AVOID GOING INTO THE CASS COUNTY COUNCIL ON AGING BUILDING ON THE DAY OF THE RUN!
THERE IS A PORT-A-JOHN AVAILABLE TO USE NEAR THE TRACK. THANK YOU!