APPLICATION FORM Please fill up the form in CAPITAL letters only CHECK LIST: HAVE YOU Fully read the information? Chosen your race category (any one)? Affixed your recent passport sized photograph with face clearly visible? Attached a photocopy of your latest timing certificate. If applicable? Attached a copy of your Govt. issued photo ID proof? Space for photograph Race Category (tick any one) 21K Run (21 Km) Open 10K Run (10 Km) 5K Fun Run Please mention your t-shirt size below Please mention your t-shirt size below Please mention your t-shirt size below *First Name *Last Name Address: City/Town *State: * Pin Code: Country: *Nationality: INDIAN *Gender Male Female Other Date of Birth: / / *Mobile Number Age as on [07.01.2018] y m d Email-Address (1) (2) All registered & confirmed participants will receive a running t-shirt. Please tick your appropriate T-shirt size XS S M L XL XXL T-Shirt Size (In Inches) XS S M L XL XXL Front/Back Length 9From High Point Shoulder) 26.4 27.4 28.3 29.3 30.3 31.3 Shoulder to Shoulder 15.9 16.7 17.5 18.3 19.1 19.9 Chest Width (All round) 37.0 39.4 41.7 44.9 48.0 51.2 Occupation: (tick any one) Business Self-Employed Name of organisation: Retired Student Unemployed Salaried Govt. Employee Designation: Housewife Sportsperson Where did you see or hear about our event?: (Tick any one) Radio Newspaper Television Online Outdoor Hoarding Referred by a friend Others (If yes, where?) *Contact name & number of family / friend/ guardian in case of emergencies (such person should not be a participant of the event) * Name: *Mobile Number: ( What will be your target finish for 21K (hrs) (min) (For e.g. 02:05) or for the 10K (hrs) (min) (Timing mentioned here is only for our information and will not be considered for line-up-sections allocated for race day. Line up section will be allocated on this basis of timing mentioned on the timing certificated submitted along with this application.) PAYMENT INFORMATION (tick any one) Cash Amount in Rs.
Waiver (must be signed for entry acceptance) I ----------------------------- (full name), declare, confirm and agree as follows that I/my ward. (i) have given true and complete information in this application form and me/my ward is/am solely responsible for the accuracy of this information.(ii) have fully understood the risk and responsibility of participating in the Kolkata police SDSL half marathon or any event outlined in this application (collectively the event ) and will be participating entirely at my/his/her risk and responsibility (iii) understand the risk of participating on a course with vehicular traffic, even in the course may be regulated/policed.(iv) understand that i/my ward must be of and must train to an appropriate level of fitness to participate in such a physically demanding event and I/my ward have obtained a medical clearance from a registered medical practitioner, allowing me to participate in the events. (v) for myself/ourselves and our legal representative waive all claims of what so ever nature against any and all Sponsors of the event, Kolkata City, all political entities, authorities and officials, all contractors and construction firm working on or near the course, all Kolkata Police SDSL Half Marathon committee persons, officials and volunteers, and all other persons and entities associated with the event and the directors, employees, agents and representatives of all or any of the aforementioned including, but no limited to any claims that might result from me/my ward participating in the event and whether on account of illness, injury, death or otherwise (vi) agree that if I am/my ward is injured or taken ill or ward to a medical facility and/or to administer emergency medical treatment and I/my ward waives all claims that might result such transport and/or treatment or delay or deficiency therein. I shall pay or reimburse to you my/my wards medical and emergency expenses and I/my ward hereby authorizes you to incur the same.(vii) shall provide race official such medical data relating to me/my ward as they may request. I agree that nothing herein shall oblige the event officials or organizers or any other person to incur any expense or to provide any transport or treatment.(viii) in case of any illness or injury caused to me or my ward or death suffered by me or my ward due to any medical reasons or medical condition during the race or at any time there after as a result of the event regardless or not whether such medical reasons or conditions shall have pre-existing conditions known by me and further regardless of whether I / my ward shall have disclosed at any point in time, the existence of such reason or condition to any person, none of the sponsors of the event or any political entity or authorities and official or any contractor or construction firms working on or near the course, or any of the Kolkata Police SDSL Half marathon committee persons officials or volunteers or entitles associated with the event or the directors employee agents or representative of all or any of the aforementioned shall be held liable by me/my ward or my ward s representatives (ix) in case of any illness or injury caused to me or my wards or bed suffered by me or my wards during the event or due to any force majeure event including but not limited to fire, riots or other civil disturbance, earth quick, storms, typhoons or terrorist act none of the sponsors of the event or any political entity or authorities and officials or any contractures of constructions firms working on or near the course, or any of the Kolkata police SDSL Half Marathon committee persons official or volunteers or entitled associated with the event or the director employee agents or representative of all or any of the aforementioned shall be held liable by me / my ward or my words representatives. (x) Shall not hold the organizers and all / any of the event sponsors responsible for loss of my / his / her application form and / or application fee in transit (xi) I / my ward do agree to received information and offers of various brands /products /services as may be sent to me / my ward by the event promoters (or a person duly authorized by the promoters) on the email address given by me / my ward in this application form. (xii) I / my ward understand and agree to the event terms and guidelines Guardian s Signature is mandatory if Applicant is under 18 years on age as on 07.01.2018 Applicant s Signature Guardian s Signature Name & relation of Guardian with application Powered by: Calcutta Police Sergeants Institute
Race Categories & Application Fees Race Category (Distance) 21K Run *(21Km) All confirmed participates of 21K Run will receive race day Tee 10K Run * (10 Km) All confirmed participates of 10K Run will receive race day Tee Fun Run (Approx. 5 Km) All ers will receive a ers Tee 21K Run and 10K Run are compulsorily timed race categories. Minimum Age Eligibility [At the time of registration] Application Fees 18 years (born on or before 12.12.1999) INR 600 15 years (born on or before 12.12.2002) INR 500 12 years (born on or before 12.12.2005) INR 300 Please note: Only Indian Nationals to participate No Group Entries will be accepted for any category Please ensure that you attach a copy of your photo identity proof issued by the Government of India i.e. Passport, PAN Card or Aadhar card, along with your application form. 21K Run and 10K Run confirmed participants are required to visit Calcutta Police Athletic Club, Maidan Tent individually to collect their running bib. In case of unavoidable circumstances a participant can send his/her representative to collect running number bib on his/her behalf. Please note a representative will NOT be allowed to collect running number bib on behalf of more than ONE runner. Application Modes Application Modes Payment Modes Where Physical Only Cash At the 25 Traffic Guards across Kolkata. Address attached Online Online www.kolkatatrafficpolice.gov.in No Cheques / Demand Drafts etc. will be accepted. Important Dates Registration opens on 12 th December 2017 Registration closes on 30 th December 2017 Collection of Bibs 2 nd to 5 th January 2018 from Calcutta Police Athletic Club, Maidan Tent Are You Fit To Participate? Please review the following questions before submitting your application form. 1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? 2. Do you feel pain in your chest when you do physical activity? 3. In the past month, have you had chest pain when you were not doing physical activity? 4. Do you lose your balance because of dizziness or do you ever lose consciousness? 5. Do you have a bone or joint problem that could be made worse by a change in your physical activity? 6. Is your doctor currently prescribing drugs for your blood pressure or heart condition? 7. Are you pregnant? 8. Are you diabetic? 9. Do you know of any other reason why you should not do physical activity? If you have answered YES to any of the questions above, then please consult your physician before applying to participate in the 21K. Irrespective of whatever may be your age, we sincerely advise you to obtain a medical clearance from a registered medical practitioner/doctor before applying for the 21K. It is unfair to you and your family to risk serious illness and become a medical emergency on race day.
Run for a Cause To make Kolkata Roads Safer & Friendlier Entry Rules and Guidelines 1. Please thoroughly go through all information mentioned in the application form prior to submitting your application. Confirmation of applications received will be subject to the Entry rules and guideline given herein. 2. You may use a photocopy of the physical or a downloadable form, from www.kolkatatrafficpolice.gov.in & click on Safe Drive Save Life to send in your application. 3. Only one applicant can apply for the Event using a single form. Also, do not send in more than one entry per person; multiple applications will be rejected. 4. Applicants must submit their entries only via the Application Modes given in this form. No individual/group has been authorised to collect entries on behalf of the Event. 5. NO GROUP ENTRIES will be accepted for the any of the race categories. 6. One representative can submit application forms for maximum 5 individual runners for all race categories. 7. All confirmed participants for all the categories whether applied as an individual or through a group need to come personally to the Calcutta Police Athletic Club, Maidan Tent from 2 nd to 5 th January 2018 to collect his/her running number bib and Race Day Tee. Where any discrepancy is found in the application and documents submitted, the same will not be accepted. Application Status Post 05 working days of registrations closure, individual applicant is required to go online here and check his/her application status. Entries Not Accepted Participation in the event is subject to entry confirmation. Where your entry is not confirmed for any reason, the entry fees paid by you will be refunded on or before 15 th January 2018. Refund queries will not be entertained post 30 th December 2017. 1. Confirmed participants of 21K/10K who are unable to participate on race day due to unavoidable circumstances like injury or illness, will now be able to surrender their bibs to Kolkata Police. The application fees paid will be refunded 2. Confirmed participant can only surrender his/her bib with effect from 1st January 2018 to 4th January 2018 by filling the bib surrender request form online on our event website here. 3. Requests for cancellation/bib surrender and thereby, refund will not be entertained post 30 th December 2017. 4. Application fees shall not be refunded by virtue of non-participation, including failure by a confirmed participant to collect his/her bib from Calcutta Police Athletic Club. 5. Running number bib collection:
a. All confirmed participants for all the categories whether applied as an individual or through a group need to come personally to the Calcutta Police Athletic Club, Maidan Tent from 1 st to 5 th January 2018 to collect his/her running number bib between 11 am to 7 pm. b. No running number will be posted to individual mailing addresses nor distributed on race day. c. It is mandatory for a 21K/10K participant to collect his/her running number personally from the Calcutta Police Athletic Club, Maidan Tent. In case of unavoidable circumstances, such runner can send his/her authorised representative to collect running number bib on his/her behalf. Please note, a representative will not be allowed to collect running number bib on behalf of more than ONE 21K/10K Run participant. d. Authorised representative must carry with him/her i. The website confirmation downloaded from application status ii. Photocopy of photo-identity proof (Aadhar card, PAN Card or passport) of the representative and the confirmed participant. 6. Confirmed runner s identity and proof of residence may be verified for validating the details provided by you in the form. Where any information and/or any document provided by an applicant/runner at any point in time is found to be incorrect, participation of the said runner shall be withheld / disqualified and there will be no refund of application fees paid by the runner. 7. All participants race day images will be screened visually after the race and if any of the participant is found not wearing the running number bib allotted to him/her, the participant registered for that bib will be disqualified from the race. Kolkata Police reserves the right to take necessary legal action against the registered participant and the person who has used the running number bib on race day, for impersonation Timing Certificates On race day timing results and certificates will be generated only for runners who complete the 21K run in 3 hours 30 mins and the 10K run under in 1 hour 40 mins from start time. Age Group Age group Age group Age group Age group 21K 18 yrs to 30 yrs 31 yrs to 45 yrs 46 yrs to 60 yrs Above 60 years 10K 15 yrs to 40 yrs 31 yrs to 45 yrs 46 yrs to 60 yrs Above 60 years 5K Fun Run 12 yrs to 30 yrs 31 yrs to 45 yrs 46 yrs to 60 yrs Above 60 years Race Time Assembly Time Race Start 21K 05:00 hrs 06:00 hrs 10K 05:30 hrs 06:30 hrs 5K Fun Run 06:00 hrs 07:00 hrs
Prize Money & More Race Category 21K 10K 5K 18 yrs to 30 yrs 1 25,000 25,000 2 15,000 15,000 1 20,000 20,000 2 10,000 10,000 All FINISHSERS to get Medal 3 10,000 10,000 3 5,000 5,000 4 5,000 5,000 4 3,000 3,000 31yrs to 45 years 1 25,000 25,000 2 15,000 15,000 1 20,000 20,000 2 10,000 10,000 All FINISHSERS to get Medal 3 10,000 10,000 3 5,000 5,000 4 5,000 5,000 4 3,000 3,000 46 years to 60 years 1 25,000 25,000 2 15,000 15,000 1 20,000 20,000 2 10,000 10,000 All FINISHSERS to get Medal 3 10,000 10,000 3 5,000 5,000 4 5,000 5,000 4 3,000 3,000 Above 60 Years 1 25,000 25,000 2 15,000 15,000 1 20,000 20,000 2 10,000 10,000 All FINISHSERS to get Medal 3 10,000 10,000 3 5,000 5,000 4 5,000 5,000 4 3,000 3,000 WINNER S MEDAL Winner medals will be presented to the top 4 in 21K & 10K for both men & women MERIT CERTIFICATE All prize money winners of the 21K (as given in the prize money structure above) will receive Merit Certificates certifying their prize money winning positions. FINISHER S MEDAL All runners of the 21K, 10K & 5K Fun Run category will get a er's Medal post their run. Medals will not be posted to individual runners.
TIMING CERTIFICATE Timing certificates of 21K & 10K finishers will be available for download from the event website after 21 days from race day. Prize Money Rules 21K Race Category 1. The Rules here under relate to entitlement of prize money for the 21K categories 2. Results declared on race day will be provisional in nature and the final prize money entitlement shall be subject to the rules hereunder and race regulations. 3. All confirmed runners in the 21K category & falling within the age groups given below should start their race by 06:00 hrs. to be eligible for receiving the prize post completion of their run. 4. Runners confirmed in the 21K failing to cross the start line at 06:20 hrs. will stand disqualified. 5. The cut-off of finish time for prize money entitlement for the 21K race category is 3½ hours from respective start times. 6. Runners crossing the start line after 06:20 hrs will not be entitled to rankings 7. In addition to the above, entitlement to finish positions and Prize Money winnings are subject to a. Bib tag timing captured across all timing points on the course, including at the start and finish mats, b. Dope test results (applicable for the elite 21K athletes only), and c. Physical verification by technical officials and anti-cheat camera s. 8. An Elite athlete refusing, for reasons whatsoever, to undergo dope testing (where chosen) will be disqualified from this Event. His/her finish position at the Kolkata Police SDSL Run 2018 and consequent prize money entitlement shall stand disqualified and forfeited. 9. Runners found to have interchanged their running number bib and/or bib tag with others, will be disqualified from the competition. Such runners shall not be entitled to any timing or prize money (where applicable). 10. Prize winners declared may be required to submit further proof of identity/age, as may be required, for disbursement of prize money, failing which Kolkata Police may, at its sole discretion, withhold disbursement or disqualify the said participant from competition. 11. Post verification of results and dope test results, prize money cheques of winners falling within the finish positions as given in the prize money structure shall be drawn in the individual name of the athlete/runner. 12. Prize Money winners are subject to applicable Indian Income Tax Rules, and the same would be borne by the winner. TDS percentages will be based on the rates and rules in force as on date of disbursement. 13. Timing results: Where a runner s timing result with respect to his/her gender and/or age, is required to be updated online, the runner needs to inform to Kolkata Traffic Police no later than 15/01/2018 specifying the nature of edit required and attaching the relevant proof of change. Requests received after 15/01/2018 will not be entertained.
10K Race Category 1. The Rules here under relate to entitlement of prize money for the 10K categories 2. Results declared on race day will be provisional in nature and the final prize money entitlement shall be subject to the rules hereunder and race regulations. 3. All confirmed runners in the 10K category & falling within the age groups given below should start their race by 06:30 hrs. to be eligible for receiving the prize post completion of their run. 4. Runners confirmed in the 10K failing to cross the start line at 06:50 hrs. will stand disqualified. 5. The cut-off of finish time for prize money entitlement for the 10K race category is 1hour 40 minutes from respective start times. 6. Runners crossing the start line after 06:50 hrs will not be entitled to rankings 7. In addition to the above, entitlement to finish positions and Prize Money winnings are subject to a. Bib tag timing captured across all timing points on the course, including at the start and finish mats, b. Dope test results (applicable for the elite 10K athletes only), and c. Physical verification by technical officials and anti-cheat camera s. 8. Runners found to have interchanged their running number bib and/or bib tag with others, will be disqualified from the competition. Such runners shall not be entitled to any timing or prize money (where applicable). 9. Prize winners declared may be required to submit further proof of identity/age, as may be required, for disbursement of prize money, failing which Kolkata Police may, at its sole discretion, withhold disbursement or disqualify the said participant from competition. 10. Post verification of results and dope test results, prize money cheques of winners falling within the finish positions as given in the prize money structure shall be drawn in the individual name of the athlete/runner. 11. Prize Money winners are subject to applicable Indian Income Tax Rules and the same would be borne by the winner. TDS percentages will be based on the rates and rules in force as on date of disbursement. Timing results: Where a runner s timing result with respect to his/her gender and/or age, is required to be updated online, the runner needs to inform to Kolkata Traffic Police no later than 15/01/2018 specifying the nature of edit required and attaching the relevant proof of change. Requests received after 15/01/2018 will not be entertained. Contact Us : Event Helpline: 7603032714 / 9432610436 Website : www.kolkatatrafficpolice.gov.in E-mail : rswkp2018@gmail.com