Wild Goose Chase PO Box 2766 Vanderhoof, BC V0J 3A0

• entry form is completed in full and waiver is signed
• payment is enclosed (adults $6 - children $4)

cut out and mail

Name of Runner:________________________________ Phone:______________________ Address:______________________________________ Postal Code:__________________ Check one only: _____male _____female                             Age as of December 31/99______ Are you a member of the BC Athletics? _____yes _____no Category: (circle one only)  4km  or  8km Waiver: In consideration of the organizers accepting this entry, I hereby myself my heirs, executors and administrator, WAIVE and RELEASE any and all right and claim for any damages of any sort I may have against the organizers of the Wild Goose Chase, their agents, representatives, successors and assigns, for any injuries suffered by me at this race, or damages sustained by me as a result of this race for any cause whatsoever, including negligence.  It is EXPRESSLY UNDERSTOOD by the undersigned that this race is entered into at the sole risk of the undersigned and that all organizers of the race are exempt from liability for any and all damages sustained and any and all injury and loss including personal and property loss arising from any cause whatsoever including negligence.  (Competitors under the age of 19 must have the signature of a parent or legal guardian).    __________________________                                      ________________________________________  Athlete's Signature                                            Parent of Guardian (if under 19)