Runner Sign- Up Form

The fields with asterisks (*) are mandatory

Title* First Name * M.I. * Last Name *
Mr. Ms. Mrs.

Date of Birth* Age* Gender*

MM / DD / YYYY Male Female

Company / Group / Organization name* Position

Run Categories
3 Km 5 Km 10 Km

Contact Information
No. and Street * Town / City *

Province * Country * Postal Code

Telephone (country code-area code-number) * Mobile / Cellphone *

Fax (country code-area code-number) * Email *

Waiver / Release Agreement *

I have read the 101010 Run for Pasig River form completely and understand the policies of the event. I should not participate unless I am medically able. I understand
the nature of, and assume all risks associated with my voluntary participating in this event. Knowing these facts, I for myself or anyone else who might claim on my behalf,
affiliated with the 101010 Run for Pasig River race officials, workers or volunteers, their representatives, successors or assigns for ANY AND ALL claims or liability,
whether seen or unforeseen, for death, personal injury or property damage arising out of, or in the course of, my participation in this event.

Waiver for participants under 18 years old*

I am fully aware of the actual and potential risks in participating in this event. My Parents or guardians who’s signature appears on my claim stub has given me permission
to participate in this event and I declare that the organizers of this event will not be liable for any injuries, any loss, damage, action, claim, costs or expenses, which may
arise in consequence of my participation of the event, in any case, I will participate at my own risk.

Date Signature over printed name

For information, please visit the site www.101010runforpasigriver.com or email 101010registration@101010runforpasigriver.com