ENTRY FORM The Green Jewel Night Run 2016 .pdf

RESIT REF NO: _________________

THE GREEN JEWEL NIGHT RUN 2016 (ENTRY FORM)
EVENT DATE:
TIME:

SATURDAY, 17 DECEMBER 2016
19:00 – 23:00 (Brunei Time)

VENUE:

KOMPLEKS UTAMA BUMIPUTERA, PEKAN BANGAR,
TEMBURONG, BRUNEI DARUSSALAM.

CONTACT INFO:

+673 8 993887(M) PESATUAN C.A.R.E (FB) OFFICIAL_C.A.R.E_BN (IG)

OPEN TO LOCAL AND INTERNATIONAL RUNNERS

REGISTRATION ENDS ON: 30TH OCTOBER 2016

*Please complete the mandatory fields (*) in the application form in BLOCK LETTERS. Any incomplete detail will not be entertained.
FIRST NAME *
LAST NAME*
EMAIL*

MOBILE NUMBER*

IC / PASSPORT NUMBER*

DATE OF BIRTH*

NATIONALITY*

GENDER*

__/___/____
MALE / FEMALE

ADDRESS*
COUNTRY*

ZIP (POSTAL CODE)*

EMERGENCY CONTACT NAME*
EMERGENCY CONTACT NUMBER*

BLOOD TYPE*

*Please TICK your Running T-shirt Size according to the size chart below (Page 3)
T-SHIRT SIZE

2XS

1XS

S

M

L

XL

2XL

*Please TICK your running category, one category per participants. For participant under 15 years old MUST have your
parents/guardian approval to be able to join this event. PAYMENT MUST BE MADE IN CASH TERM ONLY
23KM MEN OPEN
23KM MAN VETERAN

BND $55.00
(55yrs Above) BND $55.00

10KM MAN OPEN

BND $45.00

3.5KM FUN RUN & WALK

BND $35.00

PAYMENT LOCATION:

23KM WOMEN OPEN
23KM WOMEN VETERAN

BND $55.00
(55yrs Above) BND $55.00

10KM WOMEN OPEN

BND $45.00

TRIULTRA SHOP - BLOCK A, UNIT 9, 1ST FLOOR, BANGUNAN DELIMA JAYA KG BERAKAS, BB2313,
OPEN DAILY 10AM-7PM, CLOSED FOR FRIDAY PRAYER 12-2PM.

PARENTS / GUARDIAN CONSENT
PARENTS / GUARDIAN NAME *
PARENTS / GUARDIAN IC#*
PARENTS/ GUARDIAN SIGN*

PARENTS / GUARDIAN CONTACT NO*

As Parents/ Guardian, I hereby allow my child to enter this
event and understood the risk and consequences involved.

PARTICIPANTS DECLARATION
I hereby declare that this signed entry form will be considered as an acceptance of organizer RULES AND REGULATION* (Stated
on Page 2) and all the above information is given correctly.

SIGNED:

DATE:

Page 1 of 4

RULES AND REGULATION
1. Runners must compete on foot and run entirely at his/hers own risk and he/she shall not hold the
organizer, event partners or sponsors responsible for any accident/injury/death/loss of property
occurring before, during or after the competition.
2. All runners who complete the route within qualifying time will receive finishing medals.
3. Participants are required to present the payment receipt and to collect their running kit.
4. The decision of the organizing committees is final in accepting entries.
No refund will be made for wrongful or multiple entries. Incomplete entry forms will not be accepted.
5. ELIGIBILLTY – 10KM and 3.5KM categories are open for all ages. However, Children under the age of
10 should be accompanied by a parent or a guardian at the race.
6. Participants under the age of 15 MUST have their parents/guardian approval to join this event
7. Winners must be presented for the prize presentation at the end of the event. Failing to do so will
forfeit the prize.
8. The organizer has the right to modify or substitute any of the rules and regulations of the event
from time to time as they deem fit.
9. If there is ambiguity in any of the provision, the organizer shall be the authority to interpret and in
doing so, the organizer will take into account of interests of all the affected participants.
10. Any updates on the rules and regulations of the event will be notified on the official Facebook page.
11. If the event has to be cancel i.e. due to occurrence of incident that is beyond the control of the
organizer and which renders it impossible or unsafe to hold the event, there shall be no refund of fees
unless the organizer deems fit to give a refund and the organizer shall not be liable for any other loss
or inconvenience cause due to such changes.
12. If you are unable to finish the race for any reason, you must inform the volunteer of the race along
the course. If you need a ride to finish line, a sweep car will transport you to the medical station at
the finish area.
13. Use of helmets by wheelchair participant is required.
14. All participants are required the wear their official bib number at all times.
15. All special needs participants are required to bring their own guardians.
16. Participants who do not complete the route within qualifying time are required to ride the sweep car
to the finishing line in order to get their finishing medals.
17. Those who are unwilling to ride on the sweep car after the qualifying time will not be given finishing
medals.
18. NO INSURANCE PROVIDED: PERSATUAN C.A.R.E do not provide any insurance, whether life or
medical or liability, for any illness, accident, bodily injury, loss, damage or theft that may arise in
connection with the attendance at, and/or participation in the event by each participant. The
participant is advised to obtain such insurance themselves if required.
19. MISCONDUCT: PERSATUAN C.A.R.E reserves the right at any time to remove the Participant from the
Event of prevent the participant taking part in the event if in the Event’s Organizer’s sole discretion ,
it considers such action necessary for safety reasons or the proper enjoyment of the event by other
participants or for any other reasonable reason.
20. No refund of the Entry Fee shall be made if the participant has acted negligently, maliciously, with
wilful misconduct or otherwise without due care and attention for the Event or other participants, so
as to cause his/her removal.
21. At their own risk & safety, all participants must be responsible for their own health.
Page 2 of 4

RUNNING T-SHIRT (23KM / 10KM & 3.5KM)

FINISHER T-SHIRT (FOR 23KM CATEGORY ONLY)

T-SHIRT SIZE CHART

Page 3 of 4

MEDALS (ALL CATEGORY WILL GET FINISHER MEDAL*)

RUNNING BIB

Page 4 of 4