*** You may register in person ***
*** Registration begins at 9:00 am Saturday October 1, 2022 ***
*** BGVFD will have cash boxes placed throughout the event for cash donations ***
*** You may also donate on BGVFD website: www.buffalogapvfd.com ***
BUFFALO GAP VOLUNTEER FIRE DEPT. PUMPER TRUCK FUNDRAISER
Saturday October 1st, 2022
REGISTRATION FOR ALL EVENTS ARE FREE!!!!!
Registration & Contact Information
(Each Individual 18 & Up Must Complete Registration Form)
(Individuals less than the age of 18 must be accompanied by an adult)
*First Name: __________________ *Last Name: __________________
*Address: _______________
*City: _____________ State: ______ *Zip/Postal Code: __________
*Phone Number: _____________________
*Email: ____________________
*DOB (M/D/YYYY): ________________
*Emergency Contact Name: ___________________________
*Emergency Contact Phone: __________________________
Event Registration
Select desired event
__________ I am WALKING the 3.1-mile route
__________ I am RUNNING the 3.1-mile route Bib #: __________
__________ I am CYCLING the 12.5-mile route Bib #: __________
(If you register online pick up bib on day of event)
1st, 2nd & 3rd prizes will be distributed to runners & cyclists.
Event Waiver
WAIVER, RELEASE, AND INDEMNITY AGREEMENT. With full knowledge that walking, running or bicycle riding is or may be a hazardous activity, and in consideration of your accepting this entry, I, intending to be legally bound for myself (and my minor child or children, as applicable), my heirs, executors and administrators, do hereby waive and release any and all rights, claims, or causes of action that I (or my minor child or children, as applicable) now or may in the future have against the Buffalo Gap Volunteer Fire Department Pumper Truck Fundraiser organizers and their respective members, officers, directors, agents, representatives and volunteers and any other individual or entity associated with the Buffalo Gap Volunteer Fire Department Pumper Truck Fundraiser in any manner or respect (hereafter referred to collectively as the “Organizers”), for any injuries, property damage or other damage suffered or incurred by me (or my minor child or children, as applicable) as a direct or indirect result of my (or my child or children) participation in the Buffalo Gap Volunteer Fire Department Pumper Truck Fundraiser, and for the same consideration I agree to hold harmless and indemnity the Organizers of and from any claims or causes of action hereafter asserted against any of the organizers as a direct or indirect result of my (or my child or children) participation in the Buffalo Gap Volunteer Fire Department Pumper Truck Fundraiser. I and on behalf of my minor child (or children) consent to use any photographs or other promotional record of this event for any legitimate reason. THIS WAIVER, RELEASE, AND INDEMNITY AGREEMENT INCLUDES, WITHOUT LIMITATION, CLAIMS OR CAUSES OF ACTION RESULTING FROM, OR ALLEGED TO RESULT FROM, THE NEGLIGENCE, GROSS NEGLIGENCE, MALICE, OR INTENTIONAL WRONGFUL ACTS OR OMISSIONS OF ANY OF THE ORGANIZERS.
Sign name to indicate you have read and agree to all terms of the event waiver:
*Signature Name: ____________________________
*Date of waiver signed: ____________________
(If the date not entered, the effective date will be the date of the event)
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