YFC 2nd Annual Joker 5 K Run - Central New York Youth For Christ

Cost:
$20 per person
with preregistration,
postmarked by April 10.
$25 after April 10
& day of race
Checks to: Central NY YFC
Prizes:
st
1 Place in each age category
The Joker’s Prize:
Prize:
For best costume!
Raffle:
Save each playing card
accumulated during the race
for a chance to win the raffle!
T-shirt:
WHEN:
Ronald Zerbe
4 Ravine Parkway
Oneonta, NY 13820
To the person that nabs the
most jokers during the route
and has the fastest time!
Mail To:
For 2nd & 3rd place
Please include registration payment,
checks made out to Central NY YFC.
Medals:
Saturday,
April 25, 2015
Registration: 8:30-10:00 AM
& number pick up
Race Start: 10:30 AM
WHERE:
Unadilla, NY
Start location:
Unadilla Elementary School
End location:
YFC Teen Center, 16 Watson St.
**Shuttle available back to
school at end of race.**
1 100 people registered
receive a t-shirt! (Guaranteed
WHAT: 5 K
for preregistered participants!)
Run & Walk
Come join the fun
& help support our Teen Center!
WHO: ALL Ages!
st
Costumes encouraged!
Registration:
Name:
__________________________
Address:
__________________________
__________________________
E-mail: ____________________
Phone: ____________________
Please check the appropriate age
category:
□ 10 & under □ 11-14 □ 15-18
□ 19-30
□ 31-40
□ 51-60
□ 61+
Gender:
□ Male
□ 41-50
□ Female
T-shirt size: □ S □ M □ L □ XL
Please read and sign waiver on
back of flier!
Central New York Youth for
Christ holds programs on Tuesday,
Thursday and Saturdays weekly
during the school year open to all
students in grades 6-12. During the
summer we have special events
and weekly programs that teens can
participate in including adventure
programs, activity based clubs and
our annual bike trip held the first full
week of August. You may contact
YFC at (607) 432-0594.
Please sign and return with race registration (on back), and registration fee (made out to Central NY
YFC) to: Ronald Zerbe, 4 Ravine Pkwy, Oneonta, NY 13820 by: April 10, 2015. After April 10, register
at the YFC office (call 432-0594 for directions and office hours) or day of race.
THE JOKER RUN: RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY
AGREETMENT (“AGREEMENT”)
In consideration of being permitted to participate in The Joker Run conducted by Susquehanna
Valley Youth for Christ, Inc. D/B/A Central New York Youth for Christ the undersigned “RELEASOR”
represents that the Participant understands the nature of the Activity and that the Participant is qualified, in
good health, and in proper physical condition to participate in such Activity. I understand that if I am
pregnant and participate I could cause harm to come to my unborn child.__________ (initial here)
RELEASOR fully understands that the Activity involves risks of serious bodily injury, including
permanent disability, paralysis, and/or death, which may be caused by Participant’s own actions, or
inactions, those of others participating in the event, the conditions in which the event takes place, or the
negligence of any one or more of the “RELEASEES” named below; and that there may be other risks either
not known to RELEASOR or not readily foreseeable at this time; and RELEASOR fully accepts and assumes
on behalf of Participant all risk of bodily injury, death or property damage due to the negligence of any one or
more of the RELEASEES or otherwise as a result of the Participant’s participation in the Activity.
RELEASOR hereby releases, discharges, and covenants not to sue SUSQUEHANNA VALLEY
YOUTH FOR CHRIST, INC. D/B/A CENTRAL NEW YORK YOUTH FOR CHRIST, UNADILLA
ELEMENTARY SCHOOL, UNATEGO COMMUNITY CHURCH, TOWN OF SIDNEY, THE VILLAGE OF
UNADILLA, THE UNADILLA FIRE DEPARTMENT its respective shareholders, administrators, directors,
agents, owners, officers, volunteers and employees, other participants, all sponsors, advertisers, and
owners and lessors of the premises on which the Activity takes place (each considered one of the
RELEASEES herein), from all liability, claims, demands, losses or damages, on account of injury to the
Participant’s person or property whether caused by the negligence of any one or more of the RELEASEES
or otherwise while Participant is participating in the Activity, including negligent rescue operations; and
further agrees that if, despite this release, waiver of liability, and assumption of risk RELEASOR, or anyone
of Participant’s behalf, makes a claim against any of the RELEASEES, RELEASOR will indemnify, save, and
hold harmless each of the RELEASEES from any loss, liability, damage, or cost, which any may incur as the
result of such claim.
I give exclusive permission to CENTRAL NEW YORK YOUTH FOR CHRIST, to take pictures that
will possibly be posted on any of the named companies websites, facebook pages, and may be used in
advertisement.
RELEASOR has read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND
INDEMNITY AGREEMENT, understand that the RELEASOR and Participant have given up substantial
rights by signing it and have signed it freely and without any inducement or assurance of any nature and
intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and
agree if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full
force and effect.
Date:______________ In case of emergency notify (Name): ____________________________________
Relationship: ________________________________ Phone #:__________________________________
______________________________________
________________________________________
Printed name of Participant
Printed name of Parent/Guardian (If Participant is under 18 years of age)
______________________________________
________________________________________
Signature of Participant
Signature of Parent/Guardian (If Participant is under 18 years of age)