GOBBLE GALLOP 5K REGISTRATION FORM
Caesar Rodney XC Team Proudly Present:
GOBBLE GALLOP 5K RUN/WALK
Hosted by Caesar Rodney High School Cross Country Booster Club
The CR Cross Country Team would like to take their athletes to the next level of competition by attending more out of state meets so that CR is represented well in the USA. With quality coaching, strong Booster Club, and dedicated athletes, the CR Cross Country Team is ready to go to the next level!
November 28, 2015
8:00 a.m. start
7:30 a.m. Registration Opens
Start: Caesar Rodney High School
239 Old North Rd.
Camden, DE 19934
Wheel measured (3.1 mi.) course through the beautiful surrounding town of Caesar Rodney High School
THANK YOU TO OUR GENEROUS SPONSORS:
Pre-registration entry fee -- $18.00 (5K only for all age categories) or $25.00 adults; $23.00 under age 10 (5K and Jr. Class Breakfast combo price). Day of race registration fees: $25.00 (5K only) or $32.00 adults; $30.00 under age 10 (5K and Jr. Class Breakfast) day of race
Check one circle below:
Awards: M & F Age Groups First & Second:
Please make check payable to CR XC Boosters
Mail form and payment to the address below:
Please allow time for postal delivery to ensure registration.
Caesar Rodney High School
c/o CR XC Coach Tucci
239 Old North Rd.
Camden, DE 19934
Name (please print) (One entry form per person):
Last:______________________________________________________ First:___________________________________________ M.I._________
Male______ Female______ Date of Birth_____________ Age_______
MM/DD/YY
Address:
Street
City State Zip
Daytime phone: _____________ _____Email: _________________________ Emergency Contact______________________________________
Unconditional release and waiver of liability, assumption of risk and indemnity agreement
In consideration for permission to participate in the Gobble Gallop Run/Walk on the date of the event I, the undersigned, or person participating in race for myself:
1) I acknowledge the hazardous nature of road running. In addition, I am qualified both physically and mentally to participate in such an event. Further, I acknowledge race shall be conducted over areas which contain traffic, paved and non-paved surfaces subject to elements and other various weather conditions including freezing. I further agree that if at any time the event appears to be unsafe, I will immediately discontinue participation.
2) I acknowledge the road running involves risks and potential serious bodily injury including permanent disability, paralysis and death. These risks may be caused by my own actions or inactions, the actions or inactions of others involved in the race, the actions or inactions others in the surrounding community not involved in the race, or other actions beyond control of race staff some of which include: high winds, rain, hail, heat, wild animals, dogs, falling objects, bicycles, and other motor operated machinery. I, the participant, fully accept and assume all such risks and responsibility for losses, costs and damages I incur as a result of participation in the Gobble Gallop 5K.
By signing below, I release and agree not to sue, indemnify and hold harmless Caesar Rodney High School., all volunteers, sponsors, race support staff, and others present on racecourse and adjacent areas. I have read this agreement, fully understand its terms and acknowledge I have given up many rights by signing. I have signed below of my own freewill not under duress or assurance of any nature. I, the undersigned, intend this to be a complete and unconditional release of all liability to the fullest extent allowed by law. Further, if any portion of this agreement is found to be invalid that the balance shall remain in full force and effect. Any bullying, arguing or becoming belligerent with director, volunteers and other participants shall result in immediate removal from results with no refund, as well as, potential criminal/civil liability. The undersigned shall also BE REQUIRED TO HAVE A GOOD TIME ~ IT'S FOR CHARITY
Signature of Athlete (Parent’s Signature if under 18 years of age) Date:
In accordance with RRCA rules, no animals allowed on racecourse for the safety of runners and walkers.
GOBBLE GALLOP 5K RUN/WALK
Hosted by Caesar Rodney High School Cross Country Booster Club
The CR Cross Country Team would like to take their athletes to the next level of competition by attending more out of state meets so that CR is represented well in the USA. With quality coaching, strong Booster Club, and dedicated athletes, the CR Cross Country Team is ready to go to the next level!
November 28, 2015
8:00 a.m. start
7:30 a.m. Registration Opens
Start: Caesar Rodney High School
239 Old North Rd.
Camden, DE 19934
Wheel measured (3.1 mi.) course through the beautiful surrounding town of Caesar Rodney High School
THANK YOU TO OUR GENEROUS SPONSORS:
Pre-registration entry fee -- $18.00 (5K only for all age categories) or $25.00 adults; $23.00 under age 10 (5K and Jr. Class Breakfast combo price). Day of race registration fees: $25.00 (5K only) or $32.00 adults; $30.00 under age 10 (5K and Jr. Class Breakfast) day of race
Check one circle below:
Awards: M & F Age Groups First & Second:
- 5k Road Race Overall M & F Master M & F
- 5K Non-Competitive Walk Overall Caesar Rodney H.S. Student M & F
- Caesar Rodney H.S. Student 13 & Under 14-18 19-29 30-39 40-49 50-59 60+over
- ADULT SM
- ADULT MD
- ADULT LG
Please make check payable to CR XC Boosters
Mail form and payment to the address below:
Please allow time for postal delivery to ensure registration.
Caesar Rodney High School
c/o CR XC Coach Tucci
239 Old North Rd.
Camden, DE 19934
Name (please print) (One entry form per person):
Last:______________________________________________________ First:___________________________________________ M.I._________
Male______ Female______ Date of Birth_____________ Age_______
MM/DD/YY
Address:
Street
City State Zip
Daytime phone: _____________ _____Email: _________________________ Emergency Contact______________________________________
Unconditional release and waiver of liability, assumption of risk and indemnity agreement
In consideration for permission to participate in the Gobble Gallop Run/Walk on the date of the event I, the undersigned, or person participating in race for myself:
1) I acknowledge the hazardous nature of road running. In addition, I am qualified both physically and mentally to participate in such an event. Further, I acknowledge race shall be conducted over areas which contain traffic, paved and non-paved surfaces subject to elements and other various weather conditions including freezing. I further agree that if at any time the event appears to be unsafe, I will immediately discontinue participation.
2) I acknowledge the road running involves risks and potential serious bodily injury including permanent disability, paralysis and death. These risks may be caused by my own actions or inactions, the actions or inactions of others involved in the race, the actions or inactions others in the surrounding community not involved in the race, or other actions beyond control of race staff some of which include: high winds, rain, hail, heat, wild animals, dogs, falling objects, bicycles, and other motor operated machinery. I, the participant, fully accept and assume all such risks and responsibility for losses, costs and damages I incur as a result of participation in the Gobble Gallop 5K.
By signing below, I release and agree not to sue, indemnify and hold harmless Caesar Rodney High School., all volunteers, sponsors, race support staff, and others present on racecourse and adjacent areas. I have read this agreement, fully understand its terms and acknowledge I have given up many rights by signing. I have signed below of my own freewill not under duress or assurance of any nature. I, the undersigned, intend this to be a complete and unconditional release of all liability to the fullest extent allowed by law. Further, if any portion of this agreement is found to be invalid that the balance shall remain in full force and effect. Any bullying, arguing or becoming belligerent with director, volunteers and other participants shall result in immediate removal from results with no refund, as well as, potential criminal/civil liability. The undersigned shall also BE REQUIRED TO HAVE A GOOD TIME ~ IT'S FOR CHARITY
Signature of Athlete (Parent’s Signature if under 18 years of age) Date:
In accordance with RRCA rules, no animals allowed on racecourse for the safety of runners and walkers.