Vermont Corporate Cup Challenge and State Agency Race
Thursday, May 20th, 2010       Registration Form

This is a sanctioned race.
Registrations must be completed and submitted online.
As well as printed, initialed, and mailed with payment (please make checks payable to GCPFS) to:
VCCCSAR  57 Orange St. Barre, VT 05641

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Waiver and Release of Liability:

I desire to participate in the Vermont Corporate Cup Challenge and State Agency Race ("Race"), May 20, 2010.

Identification of risk: I, the above named competitor, know that the running or walking in the Race involves risks of serious injury, including but not limited to falls, contact with other participants, the impact of weather including high heat and/or humidity, permanent disability and death. I understand that injuries, loss or damage might result not only from my actions, but the actions or negligence of others.
Assumption of risk: I agree that I am responsible for my safety while participating in this Race. I assume all risks of running or walking along roadways. I voluntarily assume all risks, known and unknown, seen and unforeseen, arising from my participation in the Race.

Waiver and Release: Being aware of the risks and willing to assume them, I waive, release, hold harmless and forever discharge all organizations, agents and individuals associated with the Race, including but not limited to the State of Vermont, the Vermont Governor's Council on Physical Fitness and Sports, the Race organizing committee, sponsors, volunteers, and anyone connected with the Race, from all claims, liabilities, demands, or rights of any kind, including but not limited to those arising from negligence on the part of any of the aforementioned persons or entities, for any loss, damage or injury to me or my property, or for damage caused by me or by anyone else (including Acts of God), arising from my participation in the Race. I intend for this waiver and release to bind my relatives, heirs, personal representatives, beneficiaries, next of kin and assigns.
Photograph Permission: I further grant permission for my photographic or video image to be used on the Race website or the website of the Vermont Governor's Council on Physical Fitness and Sports.
**Race participants must be at least 16 years old on race day. If participant is under 18 but at least 16, parent must sign below in the appropriate section instead of participant.

I have read this agreement carefully and understand that this agreement is a binding promise. In consideration of your acceptance of my entry fee, I hereby sign this document voluntarily.

 

 

 

 

 

 

 

 

For more information, please email info@vcccsar.org or call 802-846-7926.
Registration Fee:
$54.00 per team ($18.00 per person) if postmarked April 26th or before
$75.00 per team ($25.00 per person) if postmarked after April 26th
Make Checks payable to: GCPFS
Mail Form & Payment to: Leslie Davis-Stone, VCCCSAR - 57 Orange St., Barre, VT 05641

**Before you select submit, please review the above information you have entered/selected to be sure everything is accurate.

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Note:

• New This Year: Each Team Member MUST Sign the Registration Form
• All qualified teams must consist of 3 persons. If less than 3, the team will not be eligible for an award.
• All members on a team must be all walkers or runners not combined.
• The age of each participant must be at least 16 years old (with parental permission if age = 16 or 17).
• All members on a team must be employees, part or full time or retirees of the same employer.

If you work for the State of Vermont then your team must consist of individuals from the same Agency.
A violation of any of the above rules will result in disqualification of your team.