On-Line Registration Form

On-Line Race Entry Form

At this time we are unable to take registration directly over the internet. But you can fill out this form, print it out, and mail it to us directly with your entry fee to save a great deal of time. Please send an individual form for each race that you wish to enter

ADDRESS: St. Catharines R/R & W, PO Box 23004, Midtown Plaza, St. Catharines, Ontario, L2R 7P6

SELECT THE RACE YOU WISH TO ENTER:

SELECT RACE :

PERSONAL INFORMATION

NAME........... : ADDRESS .....:

CITY ............. : PROV/STATE:

POSTAL / ZIP: TELEPHONE.:( ) -

BIRTHDATE.(MM/DD/YY).: / / AGE ON RACE DAY:

SEX.......... Weight Class.....(if applicable)
E-MAIL ADDRESS .....:

RUNNING DATA:
Have you participated before?: T-Shirt Size (if applicable)
Are You A Member Of A Running Club? Please Print Club Name .....:

Waiver of Liability and Release - Please Read and Sign

In consideration of the acceptance of my application and permission to participate in this athletic meet, I do for myself, my heirs, exuctors, administrators, successors and assigns hereby release, waive and forever discharge any and all rights and claims for damages which I may have or which may hereafter accrue to me against the St. Catharines Roadrunners and Walkers Club, the Cites and Regions in which this athletic meet occurs and all other associations, sanctioning bodies , the sponsers of this event or their respective officers, directors, agents, servants, contractors, representatives, successors, and or/assigns of and for all damages, claims, costs, expenses, actions and causes of action, which may be sustained by me in said association with or entry in and/or arising out of my travelling to, spectating, participating in and returning from said athletic meet including any claims arising from my negligence. I have read the above statement, I understand it, and my signature confirms its full acceptance. I attest that I have full knowledge of, and assume the risks involved in this event and I am physically fit and sufficiently trained to participate in the event. I grant full permission to any and all foregoing to use my likeness participating in this event without obligation or liability to me.
SIGNATURE:______________________
(guardian if under 18) DATE:_______________________