Phone Number: What is your fundraising goal? Emergency Contact Name: What size T-Shirt would you like (circle one) Presented by If you have any questions, please contact call Ava 403.952.6872 or Dave 403 928 2526 Saturday, October 1 0, 20 20 Registration Fees: Youth $35 (must be 17 and under on race day), Adult $45, Last Minute $55 Oct 9-10 Registration Fees are not income tax deductible. Which run would you like to participate in (circle one): 3 KM 5 KM 10 KM First Name: Last Name: Address: City: Province: Country: Postal Code: Email Address (required): Gender: Date of Birth: Phone Number: Youth Medium Small Medium Large X-Large XX-Large Office Use: $ Paid by Credit Card Cheque # Cash Initials What age will you be on race day? Make a difference in 1 person' life by donating an extra $15 (___ X $15 =$ ) How did you hear about the event? Income tax receipts are issued only for donations of $50 or more. ___________________________________ ___ ___________________________________ ___________________ ___________________________________ ______________________________________________________________________ ___________________________ ______________________________________________________________________________ ___________________________________ ______________________________________________________________________ ___________________________ ___________ ___________________________ ___________________ ___________________________ ___________ _____________________ _____________________ _____________________ _______________ _______________ _______________ Saturday, October 9, 2021 Registration Fees: Youth $35 (must be 17 or under on race day), Adult $50, Last Minute $60 | Oct. 8-9 Registration Fees are not income tax deductible. Saturday, October 8, 2022 7-8 Waiver I grant permission to The Water Run & Nehemiah Construction Ministries to photograph and videotape me in the course of my par ticipation in The Water Run event, and to use my name and any photographs and videotapes of me for The Water Run & Nehemiah Construction Ministries purposes in any media and territory in perpetuity. I know that participating in physical fitness events is a potentially hazardous activity. I agree not to participate unless I am medically able and properly prepared. I should not participate without my physician's approval. I agree to abide by any decision of an event official con cerning my ability to safely participate. I assume any and all risks associated with the event; includi ng but not limited to, falls, contact with other persons or objects, the effects of weather, traffic and course conditions. As a condition of my entering this event, I, for myself, any accompanying minors, and anyone entitled to act on my behalf, waive and release The Water Run, Nehemiah Construction Ministries, the Corporation of the City of Medicine Hat, and The Great Commission Foundation, any associated or related entities, their directors, officers, employees, agents, representatives, spo nsors, volunte ers, and organizers (herein collectively called "Event Organizers"), from present and future claims and all liabilities of any kind, k nown or unknown, arising out of my participation in this event or any claims arising from the use of my name or any photog raphs or videotapes of me or related activities, even though such claim or liability may arise out of negligence or fault on the part of the Event Organizers. I agree that the Eve nt Organizers shall not be liable for any personal injury, illness, death or property loss, and I release the Event Organizers and waive all claims with respect thereto. In the event my registration fees are paid, I agree to be bound by the provisions of this waiver. I acknowledge that I will not receive any financial remuneration for any of the above and that my compensation is the opportunity to contribute to the activities of Nehemiah Construction Ministries. I have read this Waiver. I understand and accept its terms. Signature: Date: