Blues 5K Entry
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Performance Running the Blues 5K Run & 2.5K Walk

18 April 2015 -- Start at 2:00PM -- Jacksonville Beach, FL

ENTRY FORM -     USE A SEPARATE FORM FOR EACH PARTICIPANT 

Make checks payable to and mail to:                                                                                           

Performance Multisports - Blues                                                                                    

365 Charlemagne Circle, Ponte Vedra Beach, FL 32082

PRINT NAME _________________   ______________________

                              First Name                                                   Last Name

AGE (on Race Day) ____       SEX:   F   M          T-Shirt Size ____
CHECK category:   Run__     Walk__   (If not checked, we assume you are running)
  

EMAIL ___________________________________  Amount Paid ___

Emergency Contact: __________________________________ Phone _____________ 

MY ADDRESS ____________________________________________________ APT. ____

CITY ________________________________________ STATE _______ ZIP ___________

PHONE/DAY _______________ PHONE/EVE _______________   BIRTHDATE:  ___/___/___  

WAIVER: In consideration of the acceptance of my application for this entry, I, the undersigned intending to be legally bound, hereby, for myself and anyone acting on my behalf, release any and all claims for damages I may have against the event organizers, Performance Multisports, the event supporters, directors, volunteers, City of Jacksonville Beach, USA Track & Field, and any sponsors and their representatives, successors and assigns for any and all injuries and death suffered by me in said event. I attest and verify that I know that an athletic event can be a potentially hazardous activity. I acknowledge that participating in this event is inherently dangerous. I fully realize the dangers of participating in this event, and fully assume the risk associated with such participation, including but not limited to the following dangers: dehydration, hyperthermia, hypothermia, hyponatremia, collision with pedestrians, vehicles, and other event participants and fixed or moving objects, dangers arising from other surface hazards, equipment failure, inadequate safety equipment, weather conditions, animals, the possibility of serious physical and/or mental trauma and injury, including death. However, I have sufficiently trained for the completion of this event and know that I am participating at my own risk. I understand that there are more hazards than are enumerated here, and that there are unknown and unforeseeable hazards. I engage in the activity of this event with knowledge of the inherent risks of injury. I understand the risks involved in this event and I have carefully read, understand and voluntarily accept the terms of this waiver and release agreement. In addition, I agree to abide by the rules and conditions laid down for the event and to follow instructions issued by event officials. I understand that circumstances beyond the control of the event director may cause the event to be modified, postponed or relocated. I accept that the organizers reserve the right to refuse entry from persons considered to have insufficient experience or disqualify those who fail to follow the rules and conditions: ignorance is no excuse. I agree that my name, voice or picture may be used by Performance Multisports and race sponsors for promotional purposes. I affirm that the details written about me on this entry form are true. I agree it is my sole responsibility to be familiar with the course, the rules of the sanctioning body, and the special regulations of the event. I understand that there is an 8-hour time limit for completing this race, after which I will not expect the race organizers to remain at the finish area. I agree to notify the race organizers if I should decide to withdraw from this event prior to reaching the finish line. I have no physical or mental condition which, to my knowledge, would endanger myself or others if I participate in this event, or would interfere with my ability to participate in this event. I have read this waiver of liability and accept the risks and responsibility associated with entering this event. I further acknowledge that I may be required to sign an Acknowledgement, Waiver & Release from Liability (AWRL) during the registration process prior to starting the ride on the day of the event. I hereby grant permission for the free use of my name and picture in any broadcast brochure, website, or account of this event. I understand that by not pre-registering by the cut-off date listed online, I may not be able to get a souvenir T-shirt from this event. I have personally read this waiver of liability and accept the risks and responsibility associated with entering this event.

Signature _________________________ Parent_______________________ Date ______

If participant is under 18 years of age, parent or Guardian must sign.

For more information, contact Performance Multisports at 904-373-8411

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Performance Running the Blues 5K Run / 2.5K Walk on 4/18/15

 - Produced by Performance Multisports

DATE & TIME: 18 April 2015 -The 5K Run & 2.5K Walk start at 2:00PM (for the tide)

REGISTRATION:  by mail until 4/10, by sending completed entry form and fee to: Performance Multisports, 365 Charlemagne Circle, Ponte Vedra Beach, FL 32082.    AFTER 4/10: Register online until 4/16 OR Register on Race Day beginning an hour before race starting time at race site.

ENTRY FEES: Early (online or postmarked by 2/20)= $20.00;    ---  From 2/21 through 3/28 = $23.00;    ---   From 3/29 through Day of Event = $25.00

For Race Info: (904) 373-8411

PLACE: Start and finish on Jacksonville Beach in front of the Red Cross Life Saving Station, at the east end of Beach Boulevard. Look for the tall colored flags on the beach. (GPS: to 2 Oceanfront, Jacksonville Beach, FL 32250)

RACE PACKET PICK-UP & LATE ENTRY: race packet pick-up and race-day registration at the Lifesaving Station at the east end of  Beach Boulevard on race day, beginning an hour before race start.

MUST I WEAR MY RACE NUMBER BIB? To be included in race results and any prizes, you must have fully completed the entry form (online or paper), wear your race bib visibly on the front of your shirt or shorts while racing, and must turn in your bib's bottom stub at the finish to be recorded as a official participant.

Return to BLUES 5K Run Page           Return to Event Calendar page      

 

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