REGISTRATION FORM

Name
Last Middle First
Age Birthdate Gender Male Female
(mm/dd/yyyy)
Address
House # & Street Name Subdivision Barangay City Province

Contact# Company Singlet Size Race Bib#

Race Distance & Registration Fee Emergency Contact / Guardian
Regular Rate Promo Rate Date
3K – Kids 9 yrs 3K – Kids 9 yrs
Name
old & below / P330 old & below
3K / P550 /P300
Contact
3K / P500
5K / P550 5K / P500 Relationship
10K / P990 10K / P900 Guardian’s Consent for Minors
WAIVER OF LIABILITY
1. That I am a participant in the event Boracay Obstacle Run 2019 sponsored/organized by Boracay Multi Sport Club;
2. That I hereby declare that I possess the minimum age required, am physically fit as capable to undertake and
accomplished all task and activities that I am required to undergo and such other acts that this event will involve and
which may be required of;
3. That I shall abide by the standard rules and regulations of the events as well as that provide by the organization for
the orderly and safe of the event;
4. That I expressly declare that I shall hold myself solely responsible for any injury that I may suffer;
5. That further, I hereby waive and quitclaim, any all rights and claim which, my family successors in interest or assigns
could bring, on any damage and injury arising out of and in connection with holding and participation in such event;
6. That the contents of this waiver shall serve as a bar and shall cause the dismissal of any case whether judicial or
administrative which may be filed as the same shall operate as a final and complete desistance
Date

Signature over Printed Name (mm / dd / yyyy)

(PARENT/GUARDIAN IF UNDER 18 YEARS OLD)

Registration Processed by Amount Paid Official Receipt #/Reference # Registration Date

For online registrants: Email Filled-up Registration Form

Bank Name: BPI (NOT BPI FAMILY) and Deposit Slip to:
Account Name: Renelito D. Tangkay
Account #: Checking Account 2529-0521-22 boracaybeachathon@gmail.com

Name
Last First Middle
Registration Date Amount Paid Race Distance
Race # Singlet Size

Official receipt # / Reference # Singlet and Race Bib Released by Released Date

Claiming of Singlet & Race Bibs on Saturday, April 20, 2019 at Bombom Bar 8AM to 6PM