KKNSTR Application for Entry - Saturday July 14th, 2012

Cost: $120 (Canadian)

Name: ____________________________________________________________________________

Address: _________________________________________________________________________

City: _______________________ Prov./State: _______________Country: _______________

Postal/Zip Code:__________ Phone: (H):___________ (W):__________ (Cell):__________

E-mail: ____________________________________________________________

Birth Year: ______ Month: _____ Day: _____    Age on Race Day: _____

Sex: M __ F __                  T-shirt size: S __ M __ L __ XL __

Athletic Background No. Ultras: ___ No. marathons: ___ No.KKNSTR finishes: ___ No. Ironmans: ___

50-mi PR: _____         PR: ______              PR: ______        PR: ______

Other Athletic Achievements:
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Race Management reserves the right to deny entry to any runners not demonstrating
an appropriate background in endurance activities which would allow them to
complete the race in a safe and timely manner.

Special Considerations Race Management reserves the right to admit additional runners who may enhance the
competitive aspect of the race, or have contributed significantly to the
organization of the race or the sport.  If you feel you merit special consideration
for entry on either of these two grounds, please succinctly list the reasons on
reverse or attach to entry form.

OFFICIAL WAIVER AND RELEASE

As a par­tic­i­pant in the Knee Knack­er­ing North Shore Trail Run on July 14^th, 2012, I agree to all rules and will comply with them. I am aware that this type of ultra-endurance trail run may be extremelydif­fi­cult and haz­ardous even for well-conditioned ath­letes under the most favourable con­di­tions. Iunder­stand that I should not com­pete in this run unless I am in excel­lent phys­i­cal con­di­tion, havetrained ade­quately and have no med­ical con­di­tion that might be wors­ened by phys­i­cal activ­ity. Know­ingthese facts and in con­sid­er­a­tion of the accep­tance of my appli­ca­tion to par­tic­i­pate in the KneeKnack­er­ing North Shore Trail Run, I hereby for myself, my heirs, execu­tors and admin­is­tra­tors waive,release and dis­charge Kelsy Trigg, Enzo Fed­erico, offi­cials, vol­un­teers and all per­sons con­nected with this event from claims of lia­bil­ity, for any injuries to me (includ­ing but not lim­itedto death). This release extends to all claims unfore­seen, known or unknown. Fur­ther, I grant irrev­o­ca­bleper­mis­sion to the Knee Knack­er­ing North Shore Trail Run, and any media cov­er­ing this year’s race, and the autho­rized agents, con­trac­tors, and rep­re­sen­ta­tives of each, to use my name and like­ness in anypho­tographs, video­tapes, motion pic­tures, record­ings or any other records of my par­tic­i­pa­tion in thisevent for any purpose.

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SIGNATURE OF APPLICANT (PARENT OR GUARDIAN IF UNDER 18)   DATE