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1. Takbo para sa patron ng mandadala
8. Race organizer reserves the right to reject any
pasasalamat sa biyaya ng karagatan, is organized
entry or to disqualify any participant who is suspected
barangay Rosario YDTF,Sangguniang Pamahalaan PARTICIPANTS NUMBER:
to be under the influence of alcohol or having
Barangay Gumaca, Quezon.
taken band substance. Participants found dishonest
2. To join, participants are required to pay a 3 Km Run Ladies Men 15 below
will be disqualified.
non-refundable entry fee with an accomplished 3 Km Run Ladies Men 16 above
9. All protests to the result must be made in writing
and duly signed. 3 Km Run Open Men 50yrs old above
and submitted to the race organizer 1 hour after
REGISTRATION FEE (PER CATEGORY) the end of the race. Verbal protests will not be
a. 3 km run Boys, Girls = Php 50.00 LAST NAME:_________________________________
10. Race organizer may change without prior notice any
b. 3 km run 50 yrs old above = Php 50.00 FIRST NAME:_________________________________
of the rules and regulation that may deem necessary ADDRESS:____________________________________
3. Race packets containing singlet and bibs maybe
to ensure success of the race. CONTACT NUMBER:___________________________
claimed upon complete registration. Bibs or race
11. Trophies, medals and cash prizes will be given to NATIONALITY:________________________________
number are none transferable.
top finishers on awarding ceremonies right after AGE ON RACE DAY:____________________________
4. Start up time per category is as follows: BIRTHDAY:___________________________________
the last race.
3 km run 15 yrs below = 5:00 am GENDER:____________________________________
3 km run 16 yrs above = 5:05 am Boys/Girls 15 below Run SINGLET SIZE:_________________________________
3 km run 50 yrs old above = 5:10 am
3 km 1st Php 500.00 + Tropies + certificate DECLARATION OF FITNESS & WAIVER
5. Participants being paced through the race person
not officially registered will be disqualified. 2nd Php 300.00 + Medal + certificate 1. I hereby declare that I___________________
3rd Php 200.00 + certificate
6. Failure to run at start up means disqualification. with postal & residence address at _____________
7. Participants are requested to refrain from race by Boys/Girls 16 above Run 2. I hereby represent & warrant that Im physically fit
any race official, marshal, medical staff must do to take part in the race & I have no know illness
so immediately, those who violence the rules or 3 km 1st Php 500.00 + Tropies + certificate or adverse medical condition that would render
not physically fit to continue the race. 2nd Php 300.00 + Medal + certificate me unfit to participate, should I subsequently
3rd Php 200.00 + certificate discover; I shall accordingly refrain from
50 yrs old PWD Other Run
3. I agree to abide by the decision of the race
3 km 1st Php 500.00 + Tropies + certificate organizer on any issue relative to my
2nd Php 300.00 + Medal + certificate participation including but not limited to fall,
3rd Php 200.00 + certificate contact with other participants & declaration
of winner.
4. I declare that I understand the condition of activities
that I have enter to, I will abide its rules &
regulation & that all the above details are
true and correct. I am aware & accept that all Takbo para sa patron ng mandadala
participants enter at their own risk accordingly.
Pasasalamat sa biyaya ng karagatan
On behalf of myself and my heirs. I hereby OCTOBER 26, 2017
waive & release all right of claim for damages I OPPOSITE OF
may have against the organizer, sponsor for any 84 MANUEVER PLATOON (CAMPO)

illness, injury, death, damages or lost I may

sustain during or as a consequences of the activities. @ 5:00AM
I hereby declared that I have read and understand
this declaration of fitness & waiver and that PLEASE CONTACT:
I have execute this document willingly and
voluntarily. In witness whereof I have here unto
set hand this _______ day _______________, 2016,
at ______________________. CP NO. 0929-391-9324

______________________ KGD. LEO ANGELO AONUEVO

Signature of Participants CP NO. 0949-469-3417


CP NO. 0910-244-8021