Please use this form to contact us or apply for our events (Japan and Cambodia)

大会の申し込みはこちらを使ってください (日本とカンボジア)

Note: Please fill out the fields marked with an asterisk.

Waiver of Liability, Assumption of Risk, and Emergency Contact for runningincambodia running events

In consideration of being allowed to participate in any way in the above listed club sport, related events and activities, I, the undersigned, acknowledge, appreciate and agree that:

1. The risk of injury from the activities involved in these sport events is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and

2. I knowingly and freely assume all such risks, both known and unknown, and assume full responsibility for my participation; and

3. I willingly agree to comply with the stated instructions and policies and customary terms and conditions for participation. If, however, I observe

any unusual significant hazard during my presence or participation, I will

remove myself from participation and bring such to the attention of the nearest official immediately; and

4. I understand that if I choose to drive my own vehicle or be a passenger while traveling to and/or from a Club Sport or Club Sport Special Event,

insurance coverage will not apply; and

5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify and hold runningincambodia, and

their officers, officials, agents and/or employees, other sport participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event or activity (“Releases”) harmless with respect to any and all injury, disability, death, or loss or damage to personor property, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUSTATNTIAL IGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I understand, agree and acknowledge that some activities may be of a hazardous nature and/or include physical and/or strenuous activity. Understanding this, I state that I have no medical condition or impairment that might inhibit my safe and active participation in the above listed activity. In addition, I understand that runningincambodia does not provide medical

insurance coverage for activity participants and that any applicable medical insurance must be provided individually by such participants. In the case of injury or medical emergency and in the event participant, or their parent or guardian, cannot respond at the time of the emergency, runningincambodia has permission to seek, administer, or have administered whatever first aid

or emergency medical care deemed necessary for participant’s welfare, and it is understood that participant, and not University, shall be responsible for any and all charges for such health care services regardless of whether participant’s medical insurance would cover such charges.


振込先(日本のみ):

八千代銀行 幡ヶ谷支店

普通預金 0577-051-0365361

エコネツクス

振込明細は大会の受付に持って来てください。他に参加通知は送りません。質問のある方は048ー473ー0898にお問い合わせください。