COACH RODNEY BLUE CHARITABLE RUN
Saturday, Sept. 14, 2024, Galesburg main campus
One form per participant. $30 registration fee includes commemorative t-shirt, post run refreshments, and Sandburg swag.
Opening ceremony: 8:00 a.m. • 5K walk/run: 8:30 a.m. • 1K walk/run: 8:35 a.m.
Name
*
First Name
Last Name
Preferred email address
*
example@example.com
Preferred phone number
*
I am a:
*
Sandburg alumni
Sandburg Trustee, staff, or faculty
Current Sandburg student
Friend of Sandburg
Other
Check one event
*
5K walk/run
1K walk/run
I do not plan to run/walk, yet will attend.
I wish to make a donation, yet will not attend.
T-shirt Size (All participants will receive a commemorative t-shirt)
*
Small
Medium
Large
XL
XXL
XXXL
Sandburg is committed to making our events accessible to everyone. If you require an accommodation to fully participate in this event, please complete the field below by Sept. 2, 2024. We will make every attempt to implement late requests, but cannot guarantee they will be met. For questions, contact Stefani Gillen, Coordinator of Disability Support (sgillen@sandburg.edu or 309-341-5262).
*
Yes, I am requesting accommodations for myself or my guest(s).
No, I am not requesting accommodations for myself or my guest(s).
Accommodation request
If yes, please list any accommodations to fully participate in this event:
Photos will be taken at this event and may be shared on the Sandburg website or through social media. By attending the event, you consent to having your photo or your guests' photo taken while at the event.
*
I understand
Authorization and Release
I voluntarily seek to participate in this program, which involves physical activity. I understand and acknowledge that my participation in this program may involve many risks, dangers, and hazards, including risks of physical injury, disability, or death and risk of loss of use or damage to my personal property. I recognize that injuries or loss may result from unknown or unexpected risks, but may also result from equipment, materials, or facilities recommended by Carl Sandburg College, or from the acts or omissions of others, or from the unavailability of immediate emergency medical care. I have made a voluntary choice to participate in these activities despite the risks, dangers, and hazards. I understand Carl Sandburg College does not provide any accidental death, disability, dismemberment, or medical expenses insurance on behalf of the participants in College activities. I agree to assume all the risks, responsibilities, and expenses associated with my participation in the learning experiences, the related transportation, and in any other related activities, and in advance, I hereby waive liability, release, hold harmless, covenant not to sue, and forever discharge the Board of Trustees of Carl Sandburg College, and its members individually, and its officers, agents, employees, representatives, volunteers and any students acting as employees, (hereafter “releasees”) from any and all liability, claims, demands, rights, and causes of action of whatever kind, including claims for personal injury, property damage, and/or the consequences thereof and attorneys’ fees and court costs, whether caused by the negligence or carelessness of the releasees or otherwise, resulting from or in any way connected with my participation in the program. I do not have any medical or other condition that would preclude me from participating in this program. Further, I understand if I do have a condition that would impact my ability to participate, I must contact the individual in charge of the program to discuss any questions and concerns I might have regarding my ability to participate.
Signature
*
Parent/guardian signature if under 18
Emergency Contact
Name
First Name
Last Name
Relationship to participant
Preferred phone number
Payment
After submitting this registration form, you will be redirected to a separate Sandburg payment page to finalize your reservation. Please note that your reservation is not complete until you have completed payment. Registration cost is $30 per person. Registration fees are non-refundable. There is no registration fee for current Sandburg students. (See below)
IF YOU ARE A CURRENT SANDBURG STUDENT:
Once you click 'SUBMIT' in this form, your application is COMPLETE and you should receive a confirmation email. No action is needed from current Sandburg students when this form redirects to the Sandburg giving page.
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