2008 Mt. Evans Ascent Registration Form
Name ___________________________________________________
Address ________________________________________________
City __________________________ State _____Zip _________
Phone _____________________ E-Mail _____________________
Sex: __ M __ F Race Day Age______Birthdate_________
Sweatshirt Size: S M L XL XX
Shuttle Service Information:
Will you be using the race shuttle service back down to your vehicle from the finish line?_____
or: Do you have your own ride back down to the finish line?_____
Would your ride be willing to provide a ride down for other participants?___
How many?_____
Emergency contact and phone #:______________________________________________
Registration Fee:
- $55.00 before April 30th
- $70.00 May 1 - May 30
- Registration will not be accepted after May 30 or once race has filled.
A portion of your entry fee will be donated to Alpine Rescue, however additional donations are certainly appreciated.
Additional Donation to Alpine Rescue:________
Total Amount Enclosed:___________
Send completed entry and make check payable to:
Racing Underground, P.O. Box 7042, Golden, CO 80403.
Entries will not be taken by phone or fax. Once accepted, entries will not be refunded for any reason. You may transfer your entry to another runner prior to June 14, 2008 for a $10 processing fee.
Waiver Statement:
Waiver Statement: I acknowledge that this athletic event is an extreme test
of a person's physical and mental limits and carries with it the potential for
death, serious injury and property loss. The risks include, but are not limited
to, those caused by terrain, facilities, temperature, weather, condition of
athletes, equipment, vehicular traffic, actions of other people including, but
not limited to, participants, volunteers, spectators, coaches, event officials,
and event monitors, and/or producers of the event, and lack of hydration. These
risks are not only inherent to athletics, but are also present for volunteers.
I hereby assume all of the risks of participating &/or volunteering in this
event. I realize that liability may arise from negligence or carelessness on
the part of the persons or entities being released, from dangerous or defective
equipment or property owned, maintained or controlled by them or because of
their possible liability without fault. I certify that I am physically fit,
have sufficiently trained for participation in the event and have not been
advised otherwide by a qualified medical person. I acknowledge that the
Accident Waiver and Release of Liability form will be used by the event
holders, sponsors and organizers of the event in which I may participate, and
that it will govern my actions and responsibilities at said events. In
consideration of my application and permitting me to participate in this event,
I hereby take action for myself, my executors, administrators, heirs, next of
kin, successors, and assigns as follows: (A) Waive, Release and Discharge from
any and all liability for my death, disability, personal injury, property
damage, property theft or actions of any kind which may hereafter occur to me
including my traveling to and from this event, THE FOLLOWING ENTITIES OR
PERSONS: Darrin & Jill Eisman, Racing Underground, Arapaho National Forest, their directors, officers, employees, volunteers, representatives,
and agents, the event holders, event sponsors, event volunteers; (B) Indemnify
and Hold Harmless the entities or persons mentioned in this paragraph from any
and all liailities or claims made as a result of participation in this event,
whether caused by the negiligence of releases or otherwise. I hereby consent to
receive medical treatment which may be deemed advisable in the event of injury,
accident and/or illness during this event. I understand that at this event or
related activities, I may be photographed. I agree to allow my photo, video or
film likeness to be used for any legitimate purpose by the event holders,
producers, sponsors, organizers and assigns. The Accident Waiver and Release of
Liability shall be construed broadly to provide a release and waiver to the
maximum extent permissible under applicable law. I hereby certify that I have
read this document; and, I understand it's content.
Name_______________________________________ Age_________ Signature
________________________________ Date ____________ (if under 18 years old,
Parent or guardian must also sign) PARENT / GUARDIAN WAIVER FOR MINORS (Under
18 years old) The undersigned parent and natural guardian does hereby represent
that he/she is, in fact, acting in such capacity and agrees to save and hold
harmless and indemnify each and all of the parties referred to above from all
liability, loss, cost, claim or damage whatsoever which may be imposed upon
said parties because of any defect in or lack of such capacity to so act and
release said parties on behalf of the minor and the parents or legal guardian.
Print Participant's Name____________________________________ Age _________
Signature of Parent or Guardian _____________________________ Date_________