LA SALLE / SACRED HEART CHARITY RUN 2015

SUNDAY, 2 AUGUST 2015

6.00 A.M 9KM

RM 50 | EARLY BIRD | OPEN CATEGORY | UNTIL 31 MAY

RM 40 | SCHOOL CATEGORY

RM60 | NORMAL FEE | OPEN CATEGORY | CLOSING 30 JUN

TO BE SUBMITTED AT PERFORMANCE SPORTZ

GROUND FLOOR, LIKAS GOLF DRIVING RANGE,
JALAN ISTIADAT, 88400 KOTA KINABALU

RUNNER DETAILS
NAME
I/C / PASSPORT NO
GENDER

MALE

DATE OF BIRTH

DD

FEMALE
MM

YY

AGE

NATIONALITY
ADDRESS
E-MAIL
PHONE

TEE SIZE

XS

XL

EMERGENCY NAME
EMERGENCY CONTACT
CATEGORY
MEN'S OPEN (18YR OLD & ABOVE)
BOY'S OPEN (17YR OLD & BELOW)

WOMEN'S OPEN (18YR OLD & ABOVE)

GIRL'S OPEN (17YR OLD & BELOW)

WAIVER
In consideration of my participation in the LA SALLE/SACRED HEART CHARITY RUN 2015 , I agree to assume all risks incidental to such participation
(which risks may include, among other things, muscle injuries, heat and stress related issues and broken bones). On my own behalf, and on behalf of
my heirs, executors, administrators and next of kin, I hereby release, covenant not to sue, and forever discharge the Release d Parties (as defined
below) of and from all liabilities, claims, actions, damages, costs or expenses of any nature arising out of or in any way connected with my participation
in the LA SALLE/SACRED HEART CHARITY RUN 2015 and further agree to indemnify and hold each of the Released Parties harmless from and against
any and all such liabilities, claims, actions, damages, costs or expenses including, but not limited to, all legal fees and disbursements up through and
including any appeal (Claims). I understand that this release and indemnity includes any Claims based on the negligence, action or inaction of any of
the Released Parties and covers bodily injury (including death), property damage, and loss by theft or otherwise, whether suffered by me before,
during or after such participation. I declare that I am physically fit and have the skill level required to participate in the LA SALLE/SACRED HEART
CHARITY RUN 2015 . I further authorize medical treatment for me, at my cost, if the need arises. For the purposes hereof, the "Released Parties" are LA
SALLE/SACRED HEART CHARITY RUN 2015 and all LA SALLE/SACRED HEART CHARITY RUN 2015 sponsors or charities, and each of their respective
parent, subsidiary, affiliated or related companies.
I further grant the Released Parties the right to photograph and/or videotape me and further to display, use and/or otherwise exploit my name, face,
likeness, voice, and appearance forever and throughout the world, in all media, whether now known or hereafter devised, throughout the universe in
perpetuity (including, without limitation, in online webcasts, television, motion pictures, films, newspapers, and magazines) and in all forms including,
without limitation, digitized images, whether for advertising, publicity, or promotional purposes, including, without limitation, publication of LA
SALLE/SACRED HEART CHARITY RUN 2015 results and standings, without compensation, reservation or limitation, or further approval, and I agree to
indemnify and hold harmless the Released Parties for any Claims associated with such grant and right to use. The Released Parties are, however, under
no obligation to exercise any rights granted herein.
This Waiver and Release Form shall be governed by the laws of Malaysia. I certify I am 18 years of age or older and the infor mation set forth is true and
complete.
In consideration of your minor child being permitted to participate in the LA SALLE/SACRED HEART CHARITY RUN 2015 you hereby attest that, after
reading this Waiver and Release Form completely and carefully, you acknowledge that participation in the LA SALLE/SACRED HEART CHARITY RUN 2015
by your child is entirely voluntary, and that you understand and agree as the following above.

PARENTS / GUARDIAN SIGNATURE(MINOR)

OFFICE USE:

RECEIPT NO:
RM 50

PARTICIPANT'S SIGNATURE

ORDER NO:
RM 60

RM 40