Entry Form & Waiver

No entries after February 10

Email this waiver or mail to: Ulrich & Edeltraud Kamm, P.O. Box 3262, Littleton, CO 80161

After receiving your completely filled "Entry Form & Waiver", and before making a final decision regarding your participation, RDs will contact you by phone. 

First Name:                                                               Last Name:

Sex:                                                                          Birth date:

City, State, Zip code:                                                Street Address/P.O. Box:                                  

Phone (h):                                                                 Phone (w):

Health insurance for the day of the event (mandatory): Name of Insurance:

                                                                                 Group #:

Accident insurance for the day of the event:            Yes                  No

Qualification - Races completed in 2005:

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 „Winter Trails 50 Miles” 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 am fully aware of the potential dangers inherent in this event and fully accept them.

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

I have read and seen all event related information on the webpage http://www.ultrawalk.com and agree with everything stated in it.

Signature: _________________________ Date: ___________