VIVEKANANDA SERVICE SOCIETY 5K RUN WALK FOR YOUTH & YOUTH @ HEART!
ARISE, AWAKE! STOP NOT TILL THE “5K” GOAL IS REACHED The inaugural VSS 5K RUN WALK for the YOUTH & YOUTH @ HEART is a race to raise funds and awareness for Vivekananda Service Society’s, an initiative of SRKVS Alumni, effort in supporting education, healthcare, and livelihood empowerment. These funds will be deployed to empower the disadvantaged and marginalized population in the rural areas of Karnataka, initially and eventually across India. On the 150th Birth Anniversary of the Great Swami Vivekananda, we the volunteers of Vivekananda Service Society, with the generous support from Sri Ramakrishna Ashram, Mysore and Sri Ramakrishna Vidyashala, Mysore, are organizing the inaugural VSS 5K RUN/WALK for the YOUTH and YOUTH@HEART. We intend to make this an annual event, and eventually hold more races across Karnataka and India. The run welcomes people of all ages and fitness levels, from walkers to elite runners. VSS 5K RUN WALK FOR YOUTH & YOUTH @HEART! Run Details: • • •
Date: January 12th, 2014: Time: 10:00 A.M Location: Vivekananda Statue, Cheluvamba Park, Mysore Distance: 5 Kilometers loop in the area
Suggested Entry Fees • Individuals: Suggested minimum donation of Rs. 500/person • Corporate teams (5 individuals): Suggested minimum donation of Rs. 5,000/team TURN OVER FOR APPLICATION FORM -> Vivekananda Service Society is a registered charitable organization and donations are exempted from tax under section 80G of the Income Tax Act. http://www.vivekanandaservicesociety.in
VIVEKANANDA SERVICE SOCIETY 5K RUN WALK FOR YOUTH & YOUTH @ HEART!
Run Application Individual
Corporate Team
First Name: CORPORATE TEAM NAME: eMail address: Mailing address: City State EMERGENCY CONTACT NAME Any Allergies? PAYMENT METHOD: CHEQUE Cheque details: Bank/Date/Cheque No./Acct: Collected by:
Last Name:
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Contact No. PIN: EMERGENCY CONTACT PHONE NO.
CASH
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RECEIPT Receipt No.
Date:
Received with thanks from Sri/Smt/Chi: __________________________________________ _____________________________________ towards entry fee to VSS 5K FUN RUN WALK for YOUTH & YOUTH @ HEART! Vivekananda Service Society Authorised Signatory Terms & Conditions: Unless otherwise provided in connection with a specific VSS Event, once you have entered an Event, your entry fees are non-exchangeable, non-transferable, and non-refundable, under any and all circumstances, including, but not limited to, cancellation of the Event or of your participation, or change in the date, nature, or format of the Event. An Event may be cancelled or changed for any reason, including, without limitation, severe weather or other factors that threaten the safety of participants, staff, or volunteers. Cancellation or change of the date, nature, or format of an Event may be mandated by governmental officials or otherwise be at the discretion of VSS. VSS reserves the right to change the details of the Event, such as the date, start time, course, distance and/or amenities offered in connection with the Event.
Vivekananda Service Society is a registered charitable organization and donations are exempted from tax under section 80G of the Income Tax Act. http://www.vivekanandaservicesociety.in
VIVEKANANDA SERVICE SOCIETY 5K RUN WALK FOR YOUTH & YOUTH @ HEART! Waiver, Authorization, and Publicity Release WAIVER OF LIABILITY: I am voluntarily entering or agreeing to be a volunteer and participate at one or VIVEKANANDA SERVICE SOCIETY (VSS) runs, races, classes, or other event(s), as well as activities related thereto (collectively, the “Events”). I agree not to enter into or volunteer at any of the Events unless I am medically able and properly trained. I agree to abide by any decision of an Event official relative to my ability to safely complete any Event. I recognize that participation in the Events is a potentially hazardous activity and I willingly assume all risks associated with such participation, including, but not limited to, falls; contact with other participants, spectators or others, or vehicular or other traffic; the effects of the weather, including heat and/or humidity, wind, cold temperature, and wet or icy surfaces; falling tree branches or other overhead objects; and the crowded nature and other conditions of the course, all such risks being known and appreciated by me. Having read this Waiver and knowing these facts, and in consideration of your acceptance of my application for the Events, I, for myself and anyone entitled to act on my behalf, waive and release VIVEKANANDA SERVICE SOCIETY; the City of Mysore, its agencies, departments, and officials; and all sponsors and officials of the Events; and the employees, volunteers, including medical volunteers, and other representatives, agents, and successors of each of the foregoing (the “Releasees”), from present and future claims and liabilities of any kind, known or unknown, arising out of my participation in the Events, even though such claim or liability may arise out of negligence or fault on the part of any of the Releasees. I further acknowledge that VSS reserves the right to change the details (such as the date, start time, course, and distance) of, and amenities offered at, the Events at any time for any reason, and I hereby waive and release any claims that I may have as a result of any such changes. AUTHORIZATION: I grant to the Race Director and Medical Director of the Events and his designees permission to administer or arrange for any medical assistance that they deem necessary or appropriate as a result of my participation in the Events, including without limitation, arranging transportation to a hospital or other medical facility. I also grant them access to my medical records and physicians, as well as other information, relating to medical care that may be administered to me at any such medical facility as a result of my participation in the Events. PUBLICITY RELEASE: I grant permission to the Releasees to use or authorize others to use any photographs, motion pictures, video or sound recordings, or any other record of my participation in the Events, including my name, for any purpose without remuneration. GUARDIAN’S PERMISSION AND RELEASE FOR MINOR: If I am or will be applying for my child under 18 years of age to participate in, or be a volunteer at, any Events, I represent and warrant that I am the parent or legal guardian of the child and, as such, consent to my child’s participation in the Events, and I agree that the terms of the foregoing Waiver, Authorization, and Publicity Release as well as the Rules of Competition and Terms and Conditions below apply equally to my child and me and any claims I or my child may have in connection with the Events. I also waive any derivative claims that relate to or arise out of my child’s participation in the Events. I have read and agree to the Waiver, Authorization, and Publicity Release above, as well as the Rules of Competition and Terms and Conditions below. _______________________________________ Signature of participant (Must be 18 or older)
_______________________________________ Parent or guardian’s signature (if applicant is under 18)
Vivekananda Service Society is a registered charitable organization and donations are exempted from tax under section 80G of the Income Tax Act. http://www.vivekanandaservicesociety.in