Waiver Form - Irvine Lake Mud Run

Waiver Form
Irvine Lake Mud Run - Spring Break at the Lake
Irvine Lake, Silverado, CA
Saturday, March 14, 2015
In connection with the Irvine Lake Mud Run Race scheduled for March 14, 2015 (the “Race”), I attest that I am physically fit for the Race, I
have adequately trained for the Race, and that I am aware of the risks associated with the Race, including not by means of limitation, the
difficulty of navigating the obstacles integrated into this event and have attired myself for the Race accordingly. I agree to assume all risk in
connection with the Race, including not by means of limitation, my decision to enter the Race, the condition of the Race course and/or the
suitability of the Race course for the Race event, and that there is a possibility of injury, fractures or possibly death. I hereby on behalf of
myself, my heirs, executors and administrators waive and release any and all rights and claims against the following entities and persons,
and agree to indemnify and hold harmless the following entities and persons: Eco Fun Challenge, LLC, James Event Productions, Serrano
Water District, the County of Orange, and any other entity involved with the Race, their officers, directors, agents, employees and event
volunteers, with respect to any and all liability of any nature in any way arising out of the Race and my participation therein, including not by
means of limitation, the condition of the premises in or around the Race course. The foregoing release of liability includes all liability with
respect to my travel to or from the Race. I agree that there are no cancellations or refunds or transfers of my registration fee. I also
understand that photographers and video production may be taking place on the course and I hereby consent to being photographed and
that my likeness may be used for event promotion any time in the future without compensation. And that the email addressed supplied upon
registration may be sent periodic informational updates about the event as well as information on future events.
PLEASE PRINT LEGIBLY
Team Name (teams only): _______________________________________
_______________________________ ___________________________ _____________________ _________
Individual / Team Captain Name
Address
(____) ___-________ (____)____-_______
Home Phone Number
Work Phone Number
City
Zip
____/______/______ ________________________________
Date of Birth
Signature (Mandatory for each runner/or parent if entrant is under 18)
TShirt Size : _________________________________ Email Address _______________________________________________________________________ Female:† Male:†
_______________________________ ___________________________ _____________________ _________
Second Team Member
Address
(____) ___-________ (____)____-_______
Home Phone Number
Work Phone Number
City
Zip
____/______/______ _________________________________
Date of Birth
Signature (Mandatory for each runner/or parent if entrant is under 18)
TShirt Size : _________________________________ Email Address _______________________________________________________________________ Female:† Male:†
_______________________________ ___________________________ _____________________ _________
Third Team Member
Address
(____) ___-________ (____)____-_______
Home Phone Number
Work Phone Number
City
Zip
____/______/_____ __________________________________
Date of Birth
Signature (Mandatory for each runner/or parent if entrant is under 18)
TShirt Size : _________________________________ Email Address _______________________________________________________________________ Female:† Male:†
______________________________ ___________________________ _____________________ _________
Fourth Team Member
Address
(____) ___-________ (____)____-_______
Home Phone Number
Work Phone Number
City
Zip
____/______/_____ __________________________________
Date of Birth
Signature (Mandatory for each runner/or parent if entrant is under 18)
TShirt Size : _________________________________ Email Address _______________________________________________________________________ Female:† Male:†
Page 1
Use Page 3 for Additional Team Members. Make as many copies as necessary.
* Note kids run participants do not get t-shirts due to the low registration price
Send completed entry form and correct registration fee to:
Eco Fun Challenge, LLC
1442 E. Lincoln Avenue, Suite 116
Orange, CA 92865
Make checks payable to Eco Fun Challenge, LLC
“Do Not Send Cash”
Irvine Lake Mud Run, Saturday, March 14, 2015
Course Rules
1. All runners must start That Dam Mud Run in their designated Wave. Once you've obtained your Runner's Packet you
may not change your Wave. No switching races.
2. All runners shall attempt to complete every obstacle unless a demonstrated special circumstance exists.
3. All teams must start together in their assigned wave. Team times are based on the time when the entire team
crosses the Finish Line with arms linked.
4. All runners must stay on the marked course unless injured or leaving the course.
5. That Dam Mud Run is a fun, family-oriented, event. No horseplay is allowed on the course. Any runners involving
themselves in horseplay will be Disqualified and asked to leave the course.
6. Once you have finished That Dam Mud Run, please move through the Finish Line area and off the course. Do not reenter the course or play (or allow children to play) on any obstacles.
7. Remember, Course Marshals and That Dam Mud Run Staff are present to insure the safety and "fun factor" of all
runners. Please respect decisions made by them. All decisions made by the Race Director in dealing with conduct of
runners on the course are final.
8. No dogs (except guide dogs with credentials) will be allowed on the race site for any reason.
9. Most importantly; be safe, courteous, and enjoy the run!
See you in the mud!
PAUL RUDMAN
Race Director
Page 2
_______________________________ ___________________________ _____________________ _________
Additional Team Member
Address
(____) ___-________ (____)____-_______
Home Phone Number
Work Phone Number
City
Zip
____/______/_____ __________________________________
Date of Birth
Signature (Mandatory for each runner/or parent if entrant is under 18)
TShirt Size : _________________________________ Email Address _______________________________________________________________________ Female:† Male:†
_______________________________ ___________________________ _____________________ _________
Additional Team Member
Address
(____) ___-________ (____)____-_______
Home Phone Number
Work Phone Number
City
Zip
____/______/_____ __________________________________
Date of Birth
Signature (Mandatory for each runner/or parent if entrant is under 18)
TShirt Size : _________________________________ Email Address _______________________________________________________________________ Female:† Male:†
_______________________________ ___________________________ _____________________ _________
Additional Team Member
Address
(____) ___-________ (____)____-_______
Home Phone Number
Work Phone Number
City
Zip
____/______/_____ __________________________________
Date of Birth
Signature (Mandatory for each runner/or parent if entrant is under 18)
TShirt Size : _________________________________ Email Address _______________________________________________________________________ Female:† Male:†
_______________________________ ___________________________ _____________________ _________
Additional Team Member
Address
(____) ___-________ (____)____-_______
Home Phone Number
Work Phone Number
City
Zip
____/______/_____ __________________________________
Date of Birth
Signature (Mandatory for each runner/or parent if entrant is under 18)
TShirt Size : _________________________________ Email Address _______________________________________________________________________ Female:† Male:†
_______________________________ ___________________________ _____________________ _________
Additional Team Member
Address
(____) ___-________ (____)____-_______
Home Phone Number
Work Phone Number
City
Zip
____/______/_____ __________________________________
Date of Birth
Signature (Mandatory for each runner/or parent if entrant is under 18)
TShirt Size : _________________________________ Email Address _______________________________________________________________________ Female:† Male:†
_______________________________ ___________________________ _____________________ _________
Additional Team Member
Address
(____) ___-________ (____)____-_______
Home Phone Number
Work Phone Number
City
Zip
____/______/_____ __________________________________
Date of Birth
Signature (Mandatory for each runner/or parent if entrant is under 18)
TShirt Size : _________________________________ Email Address _______________________________________________________________________ Female:† Male:†
In connection with the Irvine Lake Mud Run Race scheduled for March 14, 2015 (the “Race”), I attest that I am physically fit for the Race, I
have adequately trained for the Race, and that I am aware of the risks associated with the Race, including not by means of limitation, the
difficulty of navigating the obstacles integrated into this event and have attired myself for the Race accordingly. I agree to assume all risk in
connection with the Race, including not by means of limitation, my decision to enter the Race, the condition of the Race course and/or the
suitability of the Race course for the Race event, and that there is a possibility of injury, fractures or possibly death. I hereby on behalf of
myself, my heirs, executors and administrators waive and release any and all rights and claims against the following entities and persons,
and agree to indemnify and hold harmless the following entities and persons: Eco Fun Challenge, LLC, James Event Productions, Serrano
Water District, the County of Orange, and any other entity involved with the Race, their officers, directors, agents, employees and event
volunteers, with respect to any and all liability of any nature in any way arising out of the Race and my participation therein, including not by
means of limitation, the condition of the premises in or around the Race course. The foregoing release of liability includes all liability with
respect to my travel to or from the Race. I agree that there are no cancellations or refunds or transfers of my registration fee. I also
understand that photographers and video production may be taking place on the course and I hereby consent to being photographed and
that my likeness may be used for event promotion any time in the future without compensation. And that the email addressed supplied upon
registration may be sent periodic informational updates about the event as well as information on future events.
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