REGISTRATION FORMCentennial Jubilee Sunset Fun Run

18 August 2012Registration No:_________

Fun Run Category: Participant Status:

5K Run - Ateneo to Ateneo Sunset Fun Run Grade School Post-Graduate 2K Run - Grade Schoolers Sunset Fun Run High School Alumni/Parent 1K Run - Grade Schoolers Sunset Fun Run College Faculty/Staff/Admin

Printed Name Gender Age Signature

For Participants under 18 years, name of Parent/Guardian giving the consent Signature of Parent/Guardian

Release and Waiver of Liability, Assumption of Risk and Indemnity AgreementIn consideration of participating in the Centennial Jubilee Fun Run (1K/2K/5K), I represent that I understand the nature of

running events and that I am qualified, in good health, and in proper physical condition to participate in such an activity. I acknowledge and agree that, if I believe event conditions are unsafe, I will immediately discontinue participation in the activity. Furthermore, I will comply with instructions as provided by the Centennial Jubilee Fun Run organizers, I will follow the stated route, and I will not embark until support staff is in place and the Fun Run route is officially opened.

I fully understand and agree that running events are inherently dangerous activities that involve risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the “releasees” named below or other causes; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages I incur as a result of my participation in the activity.

I hereby release, discharge, and covenant for myself, my heirs, executors and administrators, not to sue the Ateneo de Zamboanga University, Grade School Parents-Teachers Association, volunteers, other participants, additional sponsors, advertisers, and, if applicable, owners and lessors of premises on which the activity takes place (each considered one of the “RELEASEES” herein) from any and all liability, claims, demands, losses, causes of action or damages of whatever kind or nature, arising from or related in any way to my participation in the Fun Run caused or alleged to be caused in whole or in part by the negligence of the “releasees” or other causes, including negligent rescue operations. I further agree that if, despite this release, waiver of liability, and assumption of risk, I make a claim against any of the “releasees,” I will indemnify, save, and hold harmless each of the “releasees” from any loss, liability, damage or cost which may be incurred as the result of such claim, including reasonable attorney’s fees.

Registration Fee SlipTo be filled up by the Registration in-charge

(Registrant’s Copy)

Registration No:_______________ Date_________________This is to acknowledge receipt of One Hundred (Php 100.00) Pesos from ________________________________ as Registration Fee for the 5K 2K 1K Centennial Jubilee Fun Run on 18 August 2012 at 4:00 in the afternoon.

The Registration fee is inclusive of Certificate of Participation, Running Bib and drinking water on six water stations stationed on the entire stretch of the fun run route. Please present this slip on the day of the fun run to claim your running bib.

Payment Received by:_____________________________