Jack Quinn’s 5K Championship
Official Entry Form
Join us for the inaugural Jack Quinn’s 5K Championship Race! June 2, 2012 in Monument Valley Park
Two categories to choose from:
- Fun Run - - Championship 5K -
· Untimed run/walk · Chip timed Race
· Starts at 3:30 · Starts at 5:00
· Walkers, Strollers, Families, Pets are all welcome! · Runners only
à Custom JQRC pint glasses will be given to the first 800 paid registrants.
à Anyone can race but only “Shirted” members are eligible to become the JQRC Champion.
à Age group and Overall awards will be held at Jack Quinn’s upstairs at 6:30
Packet pick-up will be May 29th from 5-8PM at Jack Quinn’s and June 1st from 2-7PM at Jack Quinn’s
Please Print Clearly______
Last Name First Name MI
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Street Address City State Zip
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Email Address Phone
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Male Female Date of Birth M/D/Y Age on 6/2/12 # of Quinn’s runs
Championship Race : Fun Run :
ÿ 5k race less than 10 runs $30 ÿ 5k Fun Run $20
ÿ 5k race 10-49 runs $25 ÿ 5k Fun Run ages under 12 FREE!
ÿ 5k race 50-99 runs $20
ÿ 5k race 100-199 runs $15 Race Day Registration:
ÿ 5k race 200+ runs FREE! ÿ 5K Race / Fun Run $35
For more information : www.jackquinnsrunners.com Make Checks Payable : Jack Quinn’s Running Club
Bring this registration to the Jack Quinn’s Tuesday night run 5:00 – 8:00
or drop off at Boulder Running Company during normal business hours
All participants in the Jack Quinn’s 5k Race/Fun Run (collectively the events) and related events are required to assume all risk of participation in the events by signing this general release agreement: The undersigned athlete (Athlete) and on behalf of Athlete’s personal representatives, assigns, heirs and executors, fully and forever releases from all liability, including negligence, Monument Valley Park and Jack Quinn’s Running Club, all municipal agencies whose property or personnel are used, and all other sponsoring or co-sponsoring companies or individuals related to the Events. Athlete and on behalf of Athlete’s personal representatives, assigns, heirs and executors waives the right to sue Releasees for all losses and damages that arise from any injury to Athlete or Athlete’s property or resulting in Athlete’s death in connection with the Athlete’s participation in the Events including but not limited to losses or damage caused by negligence of all or any of the Releasees or otherwise and also including any pre or post-race activities and all programs and/or giveaways conducted at the events/activities by a sponsor or other third party. The Athlete warrants that Athlete is in good physical condition and is able to safely participate in the Events. The Athlete is fully aware of the risks and hazards inherent in participating in the Events and elects to voluntarily compete in the Events knowing such risks. The Athlete agrees to use of Athlete’s name and photographs in broadcasts, newspapers, brochures, and other media without compensation. The Athlete acknowledged that the entry fee is non-refundable and nontransferable. The Athlete acknowledges that Jack Quinn’s Running Club has the right to alter, change, cancel and/or postpone any of these events as a result of circumstances that would affect or impact the event which are beyond their control. The Athlete warrants that all statements made in this release agreement are true and correct and understands that Releasees have relied on them in allowing Athlete to participate in the Events. ATHLETE HAS READ THE FOREGOING AND INTENTIONALLY AND VOLUNTARILY CERTIFIES COMPLIANCE BY ACCEPTING THIS WAIVER AND LIABILITY AND RELEASE
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Signature of Participant Date Signature of Parent or Guardian (If Participant is under 18 years of age) Date
All proceeds Stay with JQRC to keep our club running!