Café to Café 150

Entry Form

Only completely filled forms with included entry fee will be accepted.

Send to: Ulrich and Traudl Kamm, P.O. Box 740 564, Arvada, CO 80006-0564, USA

First Name:	Last Name:
Sex:     F     M     (please circle)	Birthdate:
Street Address / P.O. Box:	City, State, Zipcode:	Country:
Phone (h):	Phone (w):	Email:

 

Health insurance for the days of the event:	yes	no
Accident insurance for the days of the event:	yes	no

What qualifies me to participate:

Name, address and telephone number of relative or friend (who will not be present at the event):

I have the following medical and/or physical condition(s) which should be noted by the Race Directors, as they may affect my ability to safely take part in this event (please list also any medications that you are routinely taking):

Check is included for (please circle):

·         Entry    $30

·         Award   $30

·        Shirt     $30 – Please circle:       S          M         L          XL

WAIVER OF LIABILITY - ASSUMPTION OF RISK

I do hereby release and discharge the Race Directors and any and all persons assisting in the „Café to Café 150" and their respective representatives, whether compensated or uncompensated, of any and all liability arising from any and all illness, injuries, and damages I may suffer as a result of my participation in this event. This waiver of liability and assumption of risk specifically includes, but is not limited to, any liability resulting from:

(1) Availability or inadequacy of aid stations;

(2) Availability or inadequacy of traffic control;

(3) Failure to warn of hazards on the course;

(4) Failure to have adequate pick up crews to assist walkers who are lost or develop difficulties;

(5) Failure to provide or inadequacy of medical support and facilities.

I further state that I am in proper physical condition to participate in this event and suffer from no medical conditions that would put me at risk for injury or death as a result of my participation in this race. Alternatively, I assume the full risk for any death or injury that occurs as a result of any such condition and my participation in this event. I am participating in this event as a recreational event in which I will maintain a safe lookout at all times and assume the risk for any traffic or hazards encountered during the event.

By my signature hereto, I acknowledge that I have read the above waiver of liability and assumption of risk and that I concur in its entirety.

I have read the "Event Information" and agree with everything stated in it.

 

Signature: __________________________________ Date: ___________