Mannum Fun Run & Walk Registration 2019

The Mannum Fun Run & Walk will be held on Sunday, November 10, 2019.

Each year the event attracts hundreds of people of all ages, and promotes awareness around the importance of maintaing good health through regular physical activity.

To register for the event, please fill in the following boxes:

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* 1. Which category are you registering for?

3km walk

3km run

3km gopher / wheelchair / motorised scooter

5km walk

5km run

10km run (2 laps of 5km course)

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* 2. If Registering for a Child under 10 years of age -
Would you like to register your child for the Under 10's Kids Dash
(this event will commence once all other categories are finished)

Yes

N/A (my child is 10 or over)

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* 3. Surname:

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* 4. First name:

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* 5. What age category are you?
(Please note this section is for statistical reasons only, 1st and 2nd place will only be recorded for each category above.)

0-4 years

5-9 years

10-14 years

15-19 years

20-29 years

30-49 years

50-59 years

60+ years

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* 6. Street Address:

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* 7. Suburb:

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* 8. State:


Please select	Please select menu

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* 9. Contact number:

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* 10. Email address:

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* 11. Emergency contact name:

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* 12. Emergency contact number:

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* 13. Do you have any medical conditions?

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* 14. PARTICIPANT WAIVER (Please read carefully before signing/completing)

I hereby assume the risks of participating in the Mannum Fun Run & Walk 2019;

I hereby take the following action for myself, my executors, administrators, heirs, next of kin, successors and assigns, or anyone else who might claim or sue on my behalf, and expressly acknowledge that it is my intent to take these actions;

I AGREE that prior to participating, I will inspect the course, facilities, equipment and areas to be used and if I believe any to be unsafe I will advise the person supervising the event, activity, facility or area;

WAIVE, RELEASE, AND DISCHARGE FROM ANY AND ALL CLAIMS, LOSSES, OR LIABILITIES FOR DEATH, PERSONAL INJURY, PARTIAL OR PERMANENT DISABILITY, PROPERTY DAMAGE, MEDICAL OR HOSPITAL BILLS, THEFT OR DAMAGES OF ANY KIND, INCLUDING ECONOMIC LOSSES AND LOSS AND/OR STOLEN ITEMS, WHICH ARISE OUT OF OR RELATE TO MY PARTICIPATION IN, OR MY TRAVELLING TO AND FROM THE EVENT, THE FOLLOWING PERSON OR ENTITIES: Mid Murray Council, sponsors and all other person involved in the organisation of the Mannum Fun Run & Walk of any of the above even if such claims, losses, or liabilities are cause by the negligent acts or omissions of the person I am hereby releasing or are caused by the negligent acts of any other person or entity;

I AGREE NOT TO SUE ANY OF THE PERSONS OR ENTITIES MENTIONED IN THE ABOVE PARAGRAPH for any of the claims, losses, or liabilities that I have waived, released or discharged herein; I INDEMNIFY AND HOLD HARMLESS THE PERSON AND ENTITIES MENTIONED IN ABOVE PARAGRAPH for any and all claims made or liabilities assessed against them as a result of (i) my actions or inactions, (ii) the actions, inactions or negligence of other including those parties hereby indemified; (iii) the condition of the facilities, equipment, or areas where the event is being conducted; (iv) the Competitive Rules; or (v) any other harm caused by an occurrence related to the Mannum Fun Run and Walk; and

I GRANT PERMISSION for the use of my name and photograph and/or likeness relating to my participation in the Mannum Fun Run and Walk; and I waive all right to any future compensation to which I may otherwise be entitled as a result of the use of my likeness;

I consent to my address being added to any information mail out lists used by Mid Murray Council in line with its privacy policies. I understand that events occasionally need to be cancelled and/or published information needs to change. In such circumstances, Mid Murray Council will do its best to supply a comparable event. Cancellation of the event may occur if weather conditions provide to be too dangerous. If an event is cancelled information will be provided at the event and prior to the event on www.mid-murray.sa.gov.au and www.facebook.com/MidMurrayHealthFitnessAndYouth/

I (please add name below)

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* 15. CONSENT

HEREBY AFFIRM THAT I AM SIXTEEN (16) YEARS YEARS OF AGE OR OLDER. I HAVE READ THIS DOCUMENT AND UNDERSTAND ITS CONTENT

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* 16. FOR PARTICIPANTS UNDER SIXTEEN (16) YEARS OF AGE A PARENT OR LEGAL GUARDIAN MUST ALSO COMPLETE THE FOLLOWING SECTIONS (If you are over 16 please complete below sections with N/A)

I (please complete your name)

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* 17. The above mentioned parent/guardian/caregiver is the parent and natural or legal guardian of (add minor's name below)

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* 18. PARTICIPANT WAIVER (to be completed by Parent/Guardian for all minors under 16 years of age).

hereby acknowledges that he or she has executed the forgoing PARTICIPANT WAIVER for and on behalf of the minor/s named herin. As the natural or legal guardian of such a minor, I hereby bind myself, the minor and our executors, administrators, heirs, next of kin, successors and assigns to the terms of the foregoing PARTICIPANT WAIVER. I represent that I have the legal capacity and authority to act for and on behalf of the minor/s named herein, and I agree to indemnify and hold harmless the persons or entities mention in the foregoing PARTICIPANT WAIVER for any claims made of liabilities assessed against them as a result of any insufficiency of my legal capacity or authority to act for and on behalf of the minor/s in the execution of the foregoing PARTICIPANT WAIVER or in the execution of this Consent. I hereby authorise any licensed physician, emergency medical technician, hospital or other medical or health care facility ("Medical provider") to treat the minor/s named herin for the purpose of attempting to treat or relieve any injuries received by said minor/s arising out of or relating to the Mannum Fun Run and Walk. I authorise such Medical Provider to perform all procedures deemed medically advisable in the attempting to treat or relieve such injuries. I consent to the administration of anesthesia as deemed advisable during the course of treatment. I realize and appreciate that there is a possibility of complications and unforeseen consequences in any medical treatment, and I assume any such risk for and on behalf of said minor/s and myself. I acknowledge that no warranty is being made as to the results of any medical treatment.
NOTE: PARENT/GUARDIAN MUST ALSO COMPLETE PARTICIPANT WAIVER ABOVE.

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* 1. Which category are you registering for?

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* 2. If Registering for a Child under 10 years of age - Would you like to register your child for the Under 10's Kids Dash(this event will commence once all other categories are finished)

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* 3. Surname:

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* 4. First name:

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* 5. What age category are you?(Please note this section is for statistical reasons only, 1st and 2nd place will only be recorded for each category above.)

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* 6. Street Address:

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* 7. Suburb:

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* 8. State:

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* 9. Contact number:

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* 10. Email address:

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* 11. Emergency contact name:

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* 12. Emergency contact number:

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* 13. Do you have any medical conditions?

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* 15. CONSENT

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* 16. FOR PARTICIPANTS UNDER SIXTEEN (16) YEARS OF AGE A PARENT OR LEGAL GUARDIAN MUST ALSO COMPLETE THE FOLLOWING SECTIONS (If you are over 16 please complete below sections with N/A)I (please complete your name)

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* 17. The above mentioned parent/guardian/caregiver is the parent and natural or legal guardian of (add minor's name below)

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* 18. PARTICIPANT WAIVER (to be completed by Parent/Guardian for all minors under 16 years of age).

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* 19. Name of Parent/Guardian

* 2. If Registering for a Child under 10 years of age -
Would you like to register your child for the Under 10's Kids Dash
(this event will commence once all other categories are finished)

* 5. What age category are you?
(Please note this section is for statistical reasons only, 1st and 2nd place will only be recorded for each category above.)

* 16. FOR PARTICIPANTS UNDER SIXTEEN (16) YEARS OF AGE A PARENT OR LEGAL GUARDIAN MUST ALSO COMPLETE THE FOLLOWING SECTIONS (If you are over 16 please complete below sections with N/A)

I (please complete your name)