Valley Fun Color Run Sunday, August 20 @ Minnedosa Ag Grounds
Entry type: Individual Team/Family
Team name (if applicable): ______________________________________________________________
First Name: _________________________________ Last Name: _______________________________
Gender: Female Male DOB (dd/mm/yyyy): __________/__________/__________
Email: _____________________________________________ Phone: ___________________________
Mailing Address: ______________________________________________________________________
People running with you (name & age):
Name: _____________________________________________________ Age: ________________
Name: _____________________________________________________ Age: ________________
Name: _____________________________________________________ Age: ________________
Name: _____________________________________________________ Age: ________________
Emergency Contact: __________________________________________________________________
The 2017 Color Run is co-presented by the Minnedosa
Rotary Club, Minnedosa Lions Club and Minnedosa Beach
Enhancement Committee.
Please make cheques payable to: VALLEY FUN COLOR RUN
Send forms with payment to: Minnedosa Recreation Commission
39c Main Street S
Box 1259 Minnedosa, MB R0J 1E0
Registration Fees: ___________ Adult x $40
___________ Student (10-16) x $20
___________ Youth (6-9) x $10
___________ Child (5 and under) FREE
___________ Family x $100 Two adults, two children
___________ Business x $125 Team of four adults
TOTAL: __________________
Elements of Risk: The Valley Fun Color Run can involve certain elements of risk. Injuries may occur while participating in these
activities. Following are examples of the types of injury which may result from participating in the above activity. There may also be
risk of other types of injury.
1. Broken bones ex: arm, leg, finger
2. Spinal Injuries
3. Cuts, bruises and sprains
3. Other
The risk of sustaining injuries results from the nature of the activity and can occur without fault of the child, or the Valley Fun Color
Run, its employees/agents or the facility where the activity is taking place. By choosing to have you or your child take part in this
activity, you are accepting the risk that you or your child may be injured. The chance of an injury occurring can be reduced by
carefully following instructions at all times while engaged in the activity. If you choose to or choose to have your child participate in
the above described activity, you must understand that you bear responsibility for any injury that might occur. The Valley Fun
Color Run does not provide accidental death, dismemberment or medical insurance on behalf of the people participating in this
activity.
Acknowledgement: I HAVE READ THE ABOVE. I UNDERSTAND THAT IN PARTICIPATING IN THE ACTIVITY DESCRIBED
ABOVE, I AM ASSUMING THE RISKS ASSOCIATED WITH DOING SO.
If under 18 years of age:
I give ________________________________________ permission to participate in the Valley Fun Color Run. Child’s Name
Name of Parent/Guardian (Print): ___________________________________________________
Parent/Guardian Signature: ________________________ _____________
Date: ________________________________
Valley Fun Color Run Sunday, August 20, 2017 - Minnedosa Ag Grounds
If over 18 years of age: I ________________________________________ understand the risks associated and agree to participate in
the Valley Fun Color Run.
Signature: ________________________ ____
Date: ________________________________