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Step 1 of 2 - Participant Registration |
First Name | Last Name
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Address 1
| Address 2
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City
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State / Province
Use 2 digit code for US and Canada otherwise, leave blank. | Country (only if outside of the U.S. and Canada)
Leave blank if address is within US or Canada. |
Zip / Postal Code
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Primary Phone Number
Required... please provide your primary number. | Other Phone
Optional... provide an alternate phone number. |
Email Address
Participant's active Email Address... check for accuracy. |
Participant's Date of Birth
Format: YYYY-MM-DD | Sex
Gender: M for Male, F for Female. |
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Special Class: Your Race Plans
Required... for our planning purposes, please select the option that best indicates your race plans. |
Will You be Participating with Your Dog?
Required... for planning purposes, please let us know if you'll be participating with your dog. |
Your Dog's Name?
Optional... for those who'll be participating with their "best friend," what is your dog's name?! |
Waiver
This agreement releases UW-L from all liability relating to injuries that may occur during the Coulee Chase 5k/3k fun run/walk. By signing this agreement, I agree to hold UW-L entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence.
I also acknowledge the risks involved during Coulee Chase. These include but are not limited to all implications of risks involved with running activities. I swear that I am participating voluntarily, and that all risks have been made clear to me. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity.
By signing below I forfeit all right to bring a suit against UW-L for any reason. In return, I will receive participation in activity. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally. I will ask for clarification when needed. Agree to waiver by checking here.By agreeing to this waiver you submit to the terms and conditions as set forth by this event and certify that you have provided true and accurate information as requested through this registration process. |
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