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How to Enter Return Completed Form To: City of Cody Parks, Recreation & Public Facilities 1402 Heart Mountain Street Cody WY 82414 Or Mail: Completed form with payment to City of Cody Runner’s Stampede PO Box 2200 Cody WY 82414-2200 To Enter On-Line: Go to www.cityofcody-wy.gov/159/Runner’s-Stampede complete fillable form and e-mail to [EMAIL REDACTED] or fax to [PHONE REDACTED] you will be called for credit card information REGISTRATION FEE $30 PLEASE DO NOT SEND CASH MAKE CHECKS PAYABLE TO CITY OF CODY 5K Walk A fun and healthy way to start your holiday weekend Prizes will be given to the first place men and women finishers overall. 5K and 10K Run Prizes will be given to the first place men and women finishers in each age group. SATURDAY 2nd NEW DATE JULY 2ND ---PAGE BREAK--- 10K (6.2 miles) Race-day registrations will be accepted until 6:45 AM Saturday July 2nd 2016 2016 Runner’s Stampede 1. Check the race you are entering Only one entry per application, please. 5K Walk 5K Run 10K Run 2. Division Check gender and age group. Male Female 13 & under (5K only) 14-19 20-29 30-39 40-49 50-59 60 + 3. T-Shirt Size T-Shirt sizes are not guaranteed for late entries. Small__ Medium__ Large__ X-Large__ XX-Large__ 4. Name and Contact Information Full Name Address City State Zip Phone E-mail 5. Terms of Participation Please read this waiver carefully, and let us know if you have any questions or concerns. When registering yourself, your spouse, or your minor child/children for membership and participation in activities and programs sponsored by the Paul Stock Aquatic & Recreation Center you will be waiving and realizing all claims for injuries you, your spouse, or your minor child/children might sustain arising out of the use of the facility mentioned above. I hereby give my consent for myself, spouse or minor child/children to participate in recreational activities sponsored by the Cody Parks & Recreation Department in Cody, Wyoming, during any session of the recreation program. I HEREBY RELEASE THE SHOSHONE RECREATION DISTRICT, RECREATION DIRECTOR, RECREATION STAFF AND BOARD OF DIRECTORS, THE CODY PARKS & RECREATION DEPARTMENT, THE CITY OF CODY, AND ALL CITY STAFF ASSOCIATED THEREWITH FROM ALL LIABILITY, INCLUDING CLAIMS AND SUITS AT LAW OR IN EQUITY FOR ANY INJURY FATAL OR OTHERWISE, INCLUDING BUT NOT LIMITED TO CLAIMS FOR NEGLIGENCE, while participating in any of the recreation activities and understand that I will be fully responsible for any damage or injuries incurred by the participant while involved in any Recreation Department activity. Also, I hereby pledge to provide positive support, care and encouragement for my fellow competitors and league officials by following this Code of Ethics. I will encourage good sportsmanship by demonstrating positive support for all players, coaches and officials at every game. I will treat other players, coaches, fans and officials with respect regardless of race, sex, creed or ability. I understand that I am participating in a recreation activity and agree not to use profane language or engage in ‘trash talking’ at any time. I will lead, by example, in demonstrating fair play and sportsmanship to all my fellow competitors. I understand that the officials are there for my benefit and will agree not to direct any profane or threatening actions toward them (either verbal or physical). I understand that any violation of this code shall be cause for the Shoshone Recreation Board & Cody Parks & Recreation, in executive session, to deal with any behavior and/or conduct that are considered by the Board to be disruptive, destructive, and/or illegal. Behavioral problems may result in expulsion from the program without reimbursements. The Shoshone Recreation District/Cody Parks & Recreation Department does not provide any medical insurance or personal liability to cover participants during an activity. This is the responsibility of each individual involved in any recreation activity. NOTICE: The City of Cody reserves the right to take and use photographs of individuals using the Cody Recreation Center and/or participating in programs sponsored by the City of Cody. Such photographs are the property of the City of Cody, and may be used in brochures, advertisements and other promotional materials. Participant Signature (Parent/Guardian Signature if Participant is a Minor) 5K (3.1 miles) Course Map Pick up race packets at the Paul Stock Aquatic & Recreation Center parking lot between 6:00 and 6:45 AM. IMPORTANT INFORMATION: This year’s race will be held Saturday July 2nd 2016 Incomplete entries or entries submitted with insufficient funds will not be processed. A $30 fee will be assessed for returned checks. Race starts at 7 am SIGN