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October 5, 2016 :
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Reg. Form Ref. No. ______________
Reg. Form Ref. No. RACE BIB N0. LIABILITY WAIVER :
AND RACE AGREEMENT : REGISTRATION DETAILS
__________________ :
I attest to being fully trained and physically/mentally fit : Date of Registration
to participate in Run-for-a-cause and have the full : _____________________________
Sizes ( )S ( )M ( )L ( )XL ( )XXL knowledge of the risks. I assume all risks associated : Race Category ( ) 3k ( ) 5k ( ) 10k
with running and volunteering including but not limited
: Size ( ) S ( ) M ( ) L ( ) XL ( ) XXL
Date of Registration: _____________________ to falls, contact with other participants, effects of
: Name of Runner:
weather including heat and or humidity, conditions of
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Runner’s Information the road and traffic on courses. In consideration of _____________________________
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the acceptance of my application, I waive and release School/Organization
Run-for-a-cause organizers, sponsors, volunteers, race :
Name _________________________________
: _____________________________
First Name MI Last Name officials and all parties involved with this event from all
claims of any kind for damages arising from the partici- : Amount Pledged
Gender ( ) M ( )F pation of this activity. : _____________________________
:
Address ________________________________ Payment received by:
_______________________________ :
Signature over printed name _____________________________
Birthday ___________________Age _________ : (Signature over printed name)
(Parents or Guardian’s signature for participants under 18
years of age) :
School/Organization:_____________________ Date Received: ________________
:
______________________________________________ :
A fundraising project of
Mobile No. _____________________________ :
BPSTEA :
RULES AND REGULATIONS
(Bataan Public School Teachers and Employees Association)
RACE CATEGORY :  Participants below 18y/o must have their
Proceeds will be used to support teaching and non-teaching : entry form signed by a parent/
( ) 3k ( ) 5k ( ) 10k staff undergoing medical treatment. : guardian.
:
 Race BIB must be worn at all times during
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the race. It should be pinned in front
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Amount Pledge:_____________________ IMPORTANT :
of the running shirt.

Received by:________________________ :  The organizer’s decision is final.

EVENT TAKES PLACE RAIN OR SHINE :
Date:______________________________ : This serves as your acknowledgement receipt
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BPSTEA’s Copy
Registrant’s Copy