Shinetsu Five Peaks Trail Race 2024 – Patagonia Cup

100Mile RACER Check-in & Waiver Form

100 mile

Racer check-in for RACERS is scheduled as follows.
9/14 (Sat) 9:30-14:00 Racer Check-in: Madarao Kogen Restaurant Heidi
信越五岳トレイルランニングレース 2015

Racer Check-In Form

Bib #Name (First & Last Name)

Gender【Please provide your mobile phone number】 The race requires a mobile phone number with which
you can be reached during the race in case of an emergency or to contact you to ensure your safety.
Please provide your mobile phone number below.
RACER Mobile Phone #VE MOUNTAINS TRAIL - W

Important

2024 SHINETSU FIVE MOUNTAINS TRAIL - WAIVER FORM I have read and agree to all the terms and conditions in this waiver form in regard to my participation in"2024 Shinetsu Five Mountains Trail Race - Patagonia Cup" which will be held on Sept. 14 to Sept. 16,
2024.
Race Rules & Racer Responsibilities
1. I understand that this trail race takes place in the mountains and promise to abide by all the rules,
regulations and instructions laid out by the race organization. I also understand that I am responsible for themanagement of my own health and safety and agree to stop racing and drop out of the race immediately if
I feel unwell/sick.
Racer Qualifications & the Characteristics of this Race
2. I have sufficient trail running experience and I am aware that this race will be taking place in an outdoor
environment where the weather and conditions can quickly change. I am also aware that I will be in an area
where there are wild animals (such as bears) and will need to carry equipment such as a bear bell. I also
realize that a racer’s health/condition may rapidly deteriorate during such a race and understand that it may
be difficult to obtain immediate emergency assistance when out in the mountains. I am currently in good
health condition and do not expect any issues during the race. I have also undergone a medical examination
within the past year and have no health issues. I will contact the race organization before the race, in writing,regarding any allergies, medical issues and/or religious issues that the race staff should be aware of in caseI require emergency treatment during the race. As such, I will also provide any medical documentation andelectrocardiograms if asked to do so by the race.
Race Disqualification & Emergency Treatment
3. I understand and accept that the race organization may ask me to stop and drop out of the race if I am
not good enough condition to continue racing. I also agree to allow the race to provide me with emergency
medical treatment/care in case I am injured or become sick due to an accident or illness during the race. In
such a case, I will not dispute the treatment method or its outcome.
I agree to bear the cost for any medical and/or transport cost that is not covered by the insurance below.

Continued on Reverse Side→Liability Waiver in case of Injury or Death
4. I will not hold the race organization and any related parties liable for any reason whatsoever if I am
injured during the race and/or during any events related to the race. I will also not hold the race organization,
staff and volunteers liable for subsequent complications for whatever the reason including death. I
understand and agree to the insurance coverage limits for race participants (see below) provided by therace. In addition, I promise that my family, estate/will, trust, heirs nor myself will not make a liability claim,take legal action and/or demand payment including the reimbursement of legal fees.
I will not bring the race organization and any related parties liable in case any of my belongings is lost
and/or stolen.
[Insurance Coverage for Race Participants]
The following is the insurance coverage limit for each race participant as per the race’s insurance policy:- Death & disability : 5,000,000 Japanese Yen - Hospitalization : 5,000 Japanese Yen (per day)- Hospital Treatment : 2,000 Japanese Yen (per day)If you want to be insured for any amounts over and above these limits, you will need to enroll in your own
insurance plan.
Unforeseen/Uncontrollable Conditions (An Act of God/Force Majeure)
5. I will not hold the race organization and any related parties liable or responsible for any changes to therace or the cancellation of the race due to unforeseen and uncontrollable factors. These factors include but
are not limited to deteriorating weather, poor/unsafe race conditions and property damage/loss. I also
promise not to seek compensation or refunds for costs incurred to participate in the race including race entry
fees.
Photograph/Video Rights
6. I understand and agree to allow the race organization to use photographs or video images that may
include myself, my name, address, age and race experience in its promotional material as well as in othermedia publications. I also understand that this material is owned by the race organization and agree that it
can be used for commercial purposes including printed material, movies/footage and the informational
media.
Please Note: This race/event will take place within the regulations and laws governing Japan. While thecontent and rules/regulations/policies are available in both English and Japanese, the English languagetranslation is provided as a courtesy to race participants. In the event of a conflict between the Japaneseand English language versions of the site and rules/regulations/policies, the Japanese version shall govern.

I promise that all the information I've provided on my race registration form is accurate and true. My familyand relatives understand and accept the terms and conditions of this waiver form and agree to myparticipation in this race. I also understand and fully accept the race rules and regulations as well as theterms of this waiver form including the insurance coverage and have provided my signature as proof.

RACER'S SIGNATURE
Address

Full Name

Signature:Date: