BIB NO.

:

(FOR OFFICIAL USE ONLY)

PLEASE CHECK
BOX

Date: _______________
Name: _________________________________
(LAST NAME)
________________________________
(FIRST NAME)
________________________________
(MIDDLE INITIAL)

Address: ________________________________________________

________________________________________________________

Birth Date: ___________________ Age: _____

Gender: _____

Contact No. __________________


Race Categories:

2.5 km (300PHP)

5 km (400PHP)

10 km (500PHP)


Singlet Size:

S M L

LIABILITY WAIVER AND RACE AGREEMENT:
In consideration of my entry, I, my heirs and administrators release and discharge, the
organizers, the university, their student councils and administrators, their servant agents and all
volunteer community groups, all organizations assisting this event, sponsors, producers, their agents
and representatives of all liabilities, claims damages, or cost which I may have against them arising
out of, or in any way connected with my participation in this event. I understand this waiver includes
claims based on negligence, action or inaction of only the above parties. I fully recognize the
difficulty of this event and declare that I am physically fit and sufficiently trained to compete on this
event, and have not been told otherwise by a medically qualified person.
I likewise authorize, give my consent and permission to the Student Council of the College of
Engineering and Architecture to use, utilize, post, exhibit, feature and show my name, voice, picture
or video and personal information in this entry and on account of this event, without any payment
or compensation for purpose of broadcast, telecast, promotion or advertisement, including the
internet and web site of organizers of the Student Council of the College of Engineering and
Architecture.
I agree that in the event of race cancellation due to storm, rain, inclement weather, wind or
any other unforeseeable, or act of God conditions, my entry shall be non-refundable.
I have carefully read this entry form and agree to abide by all rules and directions of all officials
on the day of the race.


____________________________________________
PARTICIPANTS SIGNATURE

____________________________________________
PARENTS/ GUARDIANS SIGNATURE OVER PRINTED NAME