Gator Chase 5/15/16
Please mail completed application to:
Greentree Elementary
Attn. Shannon Brabham
3502 Brookshadow Drive
Kingwood, TX 77345
shannon.brabham@humble.k12.tx.us
Name _____________________________________ Male / Female
Address ___________________________________
Age on race day
________
City, State, Zip _______________________________
Phone (day) ________________ night ________________
Email address ___________________________________
Gator 5K _____
$ 25.00
Gator 5K & 1 Mile (age 12 and under) Combo Package _____
$ 30.00
Gator 1 Mile (age 12 and under) _____
$
15.00
Lazy Gator (spectator with shirt) _____
$ 15.00
Race Day Gator 5K _____
$ 30.00
Shirt size: Youth Small
Medium Large Adult
Small Medium Large XL
XXL circle one
Donation to Greentree Elementary to promote health and fitness
$ ________
Make check payable to: Greentree Elementary
Total Enclosed
$ ________
Waiver Must Be Signed
Waiver: All participants
in the Gator Chase events assume all risk of participation in the event by signing the
release agreement. I the undersigned athlete
on behalf of myself and on behalf of my heirs, my executors, my administrators and my
trustees, waive and release any and all rights and claims for any loss(es), injuries and
damages including, but not limited to demands or actions for negligence, premises
liability, emotional injury, intentional conduct, tort claims, and any other actions or
demands of whatever nature, I have or may have against 1) Gator Chase, 2) its officials,
agents and representatives, 3) Greentree Elementary and Humble, ISD, 4) all sponsors of
the event in which I may participate whether my participation is as a contestant or as a
spectator. I acknowledge that I am aware of
the inherent risks involved in this event and I voluntarily assume the risks. I attest and verify that I am physically fit and I
have sufficiently trained for the competition of the above-mentioned event in which I
participate. I hereby grant full permission
to any and all of the foregoing to use my name, and/or my picture in any account of this
event for any purpose whatsoever. I have read
the entry information provided for the event and certify my compliance by signing below. Athlete acknowledges that the entry fee is non-refundable
and non-transferable.
Signature of athlete_______________________________ Date ___________
* Signature of parent/guardian ______________________ Date
___________
*(if athlete is under 18) I certify that my son/daughter has my permission to compete in
the Gator Chase events, is in good physical condition and that race officials have my
permission to authorize emergency care if necessary.