5K Registration

Spooktacular 5K Dash and Bash
October 21, 2017
Sponsored by:
Edgerton Explorit Center
The Leadership Center
Aurora Elementary Parent Teacher Board

October 21, 2017
October 11, 2017 12:00pm [Central Time]
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Registrant Fee: $0.00

Billing information

Billing and Payment
Billing and payment processing for Businesses' events is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, attendance and participation in the Event. Please note, you may see all or any portion of the following on your bank or credit card statement: "MSI*EDGERTONEXPLORITCENT 8882448044 ONLINE REG FEE". Any returned payment will be assessed a $25.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.

Applicant Agreement
I represent that I am the person who appears on the application above. I acknowledge and agree to the statements, terms and conditions above, as well as any applicable terms and conditions for this registration, and that by typing my name below and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.

Applicant Signature
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Registration inquiries:
Mary Molliconi
(402) 694-4032

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Registrant Information
Terms, Conditions, and Release of Liability Agreement

I, the undersigned, hereby acknowledge that I am over the age of 18, and/or that I am the parent and/or legal guardian of the registered participant and that I have the authority to make agreements on behalf of my child, the registered minor.

I further acknowledge that I have voluntarily chosen to enroll myself or my child in the Edgerton Explorit Center Spooktacular 5K Dash and Bash. I also give consent for my or my child's participation in this activity.

I understand that certain risks are inherent in any recreational activity. I agree that there may be risk of injury or harm to me or my child as a result of event activities, and I knowingly and voluntarily assume all risks of such injury or harm. I also understand and agree that it is my and/or my child's responsibility to safeguard my/his/her personal belongings, and I knowingly and voluntarily assume all risk that personal belongings brought to the event may be lost, misplaced, damaged, or stolen. I hereby waive and release the Edgerton Explorit Center, The Leadership Center and the Aurora Parent Teacher Board [hereafter called Event Sponsors] (and all their board of directors, agents, partners, representatives, employees, contractors, and staff) from any liability, including but not limited to claims based on negligence or some other act or omission, for any injury, illness, or harm to me and/or my child or damage of any personal property incurred while at the event.

For everyone’s safety, registrants must follow all staff instructions. I understand that if I and/or my child's actions or attitude are deemed detrimental to other participants, staff, or the general event atmosphere, I /he/she may be sent home without any reimbursement for any payment made to the Event Sponsors. I agree to accept full responsibility, financially or otherwise, for the conduct of myself and/or my child — including paying restitution for damage to equipment and property, facilities, and/or personal property of other participants. The Event Sponsors are not required or expected to protect participants from theft or damage to property.

MEDICAL AUTHORIZATION & SPECIAL NEEDS PERMISSION TO TREAT I understand and agree that I am responsible for determining my and/or my child's medical, physical or other qualifications and suitability for participating in this event. I agree to disclose any pertinent medical, physical, or other conditions and special needs that may affect my and/or my child's participation in this event. I understand measures will be taken to safeguard the health and safety of all participants; however, in the event of medical attention becomes necessary I hereby grant permission to the Event Sponsors or their authorized representatives to arrange for such medical care that me and/or my child may require. This includes minor medical care by Event Sponsor staff members. In the event of serious injury or illness, the Event Sponsors will call 911. The Event Sponsors will also make all reasonable efforts to contact the parent, guardian and/or people listed as emergency contacts. I am aware that the Event Sponsors assume no liability for the costs or provision of medical care in the event that care is needed during or after this event.

This event may be videotaped or photographed. By registering for this event, I grant permission for the use of my and/or my child’s image and voice; which may be captured through video, photo, digital camera or other media; in Event Sponsors' training, promotional materials and publications, and other commercial purposes.

I understand that registration fees are non-refundable and non-transferable. The Event Sponsors reserve the right to reschedule or cancel the event if it is under-subscribed or for any other reason. The Event Sponsors aim to give participants at least 1 weeks notice if the event is rescheduled or cancelled, and give a full refund for cancelled events.

By signing this Waiver and Liability Agreement, I acknowledge that I HAVE READ AND FULLY UNDERSTAND AND AGREE TO ALL OF ITS TERMS AND CONDITIONS INCLUDING PERMISSION TO TREAT AGREEMENT. I further state that I have executed this waiver and liability voluntarily and with full knowledge of its significance to be binding on me, my heirs, executors, and administrators.

Check this box to indicate that you have read and agree to all of the above terms & conditions