Snow and Ice 100

February 24/25, 2007

Littleton / Colorado / USA

 Entry Form & Waiver

First Name, Last Name:	Gender:
Birth Date:	Email Address:
City, State, Zip Code:	Street Address/P.O. Box:
Phone (h):	Phone (w):

Health insurance for day of event (mandatory)	Name of Insurance:	Group #:
Accident insurance for day of event (circle)	Yes	No

                                                             

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

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

 

WAIVER OF LIABILITY - ASSUMPTION OF RISK

In consideration of participating in this event, I do hereby for my heirs, executors and administrators waive, release and discharge the Event Directors, branches of the government administering the lands, the land owners upon whose properties this event is held and any and all persons assisting in the „Snow and Ice 100” 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 have sufficiently trained and I attest that I am in proper physical condition to complete this event and suffer from no medical conditions that would put me at risk for injury or death as a result of my participation. 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 it 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. I know that I am alone responsible for my health and safety during the entire event. I am fully aware of the potential dangers inherent in this event and fully accept them. 

I am aware that aid stations and drop bags may not be available as planned. I will be prepared for such situations as well as for extreme weather.

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 and seen all event related information on the webpage http://www.ultrawalk.com and sub-pages, and agree with everything stated there.

Signature: _________________________ Date: ___________