SCYC Rainbow Splash Sign Up 2019
5K and Family Fun Run/Walk
Saturday, August 17, 9 AM CST
Hamlet Fire Station

The family fun run is only 1.4 miles long and perfect for kids!

One form required per participant.
Email address *
Which event are you registering for? *
Personal Information
Who Are You Registering for this Event? *
Current Age *
First and Last Name *
Your answer
Mailing Address *
Your answer
City *
Your answer
State and Zip *
Your answer
Email (I consent to receive emails from SCYC) *
Your answer
Phone Number *
Your answer
Shirt Size (Included only with Entry Fee by August 9) *
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
I understand that my registration is non-transferable and non-refundable. *
Acknowledgement and Release
By submitting this form, I understand that participating in this event is a potentially hazardous activity. I should not participate unless I am medically able. I assume ALL risks associated with my voluntary participation in this event, including but not limited to falls, contact with other participants, the effects of weather - including extreme temperatures and precipitation, and traffic. Knowing these factors, I for myself, heirs, executors, administrators or anyone else who might claim on my behalf, I agree not to sue and WAIVE, RELEASE AND DISCHARGE the City of Hamlet, Hamlet Fire Department, the Starke County Youth Club and their agents, employees, officers, directors, successors and assigns, and ALL other sponsors, workers or volunteers, their representatives, successors and assigns, and any other person or entity associated with this event in any capacity whatsoever, for ANY AND ALL claims or liability, whether foreseen or unforeseen, for death, personal injury, or property damage arising out of, or in the course of, my participation in this event. My signature below constitutes conclusive proof that I have read and understand the above terms and agree to be bound by said terms. I grant permission for organizers to use photographs of me and quotations from me in promotion of this event.
By entering my name below, I assert that I have reviewed and agree to all of the waivers and agreements I have selected above.
Electronic signature *
Your answer
The undersigned (parent/guardian) is the parent and natural or legal guardian of (minor listed above) and hereby acknowledges that he or she has executed the previous Acknowledgment and Release for and on behalf of the minor named herein. 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 Acknowledgement and Release. I represent that I have the legal capacity and authority to act for and on the behalf of the minor named herein, and I agree to indemnify and hold harmless the persons or entities mentioned in the foregoing Acknowledgement and Release 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 in the execution of the foregoing Acknowledgement and Release or in the execution of this Consent. I hereby authorize any licensed physician, emergency medical technician, hospital, or other medical or health care facility (“Medical provider”) to treat the minor named herein for the purpose of attempting to treat or relieve any injuries received by said minor arising out of or relating to the Rainbow Splash event. I authorize such Medical Provider to perform all procedures deemed medically advisable in 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 an on behalf of said minor and myself. I acknowledge that no warranty is being made as to the results of any medical treatment.
Parent / Guardian Name
Your answer
Parent / Guardian Electronic Signature
Your answer
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