to a Registration Form

RUNNING FOR DREAMS 5K
May 16, 2015
5K at 8:00 AM
1 Mile Fun Run at 9:00 AM
Fletcher Park, San Marco
ENTRY FEES
Through March 31st....................................................$25.00
April 1st - May 16th....................................................$35.00
1 Mile Run Fun...............................................................$5.00
» Sorry, there are no refunds!
»
Make checks out to 1st Place Sports Running Club
and mail with entry form to: 3931 Baymeadows Rd,
Jacksonville, FL 32217
» Register Online at www.1stplacesports.com
for Dreams 5K. Dreams Come True is the First Coast’s only
locally based nonprofit organization dedicated to fulfilling
the dreams of children who are battling life threatening
illnesses. Since 2004, JAHU has raised over $80,000 for
Dreams Come True, fulfilling the dreams of 23 precious
children in our community. Your sponsorship and support
will turn their dreams into reality.
COURSE
AWARDS
Awards will be given to the top three male and female
overall finishers and to the top three male and female
finishers in age groups from 12 and Under to 80 and over.
PACKET PICKUP
Packets will be available for pick up from 10:00 AM until 6:00
PM on Friday, May 15th at our Baymeadows and San Marco
1st Place Sports locations. Day of Race: All packets that are
not picked up at these locations will be moved to the race site
for race-day pick up starting at 6:30 AM.
SPONSORSHIP OPPORTUNITY
Please help Jacksonville Association of Health Underwriters
(JAHU) support Dreams Come True at the first annual Running
RUNNING FOR DREAMS
Official Entry Form
Please indicate where
you plan to pickup
your race packet:
May 16, 2015
Baymeadows
San Marco
Official Use Only
Day of Race
M
First Name
Age on Race Day
Last Name
Street Address
ChampionChip Number
Apt. #
Please Mark One:
City
YL
State
S
M
L
X
Cell Phone Number
5K
1 Mile
Zipcode
2X
Tshirt Size: Mens/Womens. 2XL is an extra $5
F
Sex
Email Address
Make Checks Payable to 1st Place Sports Running Club
and mail to: 3931 Baymeadows Rd., Jacksonville, FL 32217
Entry Fee
Chip Owner
Deduct $2.00
2XL Shirt
Add $5.00
$___________
$___________
TOTAL AMOUNT:
$___________
$___________
WAIVER OF LIABILITY ACKNOWLEDEMENT: I am voluntarily entering or agreeing to be a volunteer in this event. I understand that my participation in this event is physically demanding and can be a potentially hazardous activity, which could cause injury or death. I agree to not enter and participate unless I am medically able and properly trained, and by my
signature, I certify that I am medically able to perform, am in good health, and am properly trained. I assume all risks associated with my participant in this event, including but not limited to: falls, contact with other participants, the effects of the weather, including high heat and /or humidity, traffic on the course and the conditions of the course, all such risks being
Cash Check
known and appreciated by me. I understand that bicycles, skateboards, baby joggers, roller skates or blades, animals and radio headsets are not allowed in this event. I also understand that I must return the timing transponder issued to me for this event, if requested or I will be billed $30.00 as replacement cost. I also understand that if this event is canceled,
rescheduled or details are changed for any reason beyond the control of race management that I hereby waive and release any claims against this event and it’s organizers that I may have as a results of any such changes and that my entry fee will not be refunded. I understand that if I cannot participate in this event, ie injury, family emergency, etc., that I will not
receive a refund. AUTHORIZATION: I agree to abide by any decision of event’s officials relative to any aspect of my participation in this event, including the right of any event official to deny or suspend my participation for any reason whatsoever. I grant permission for event's organizers to take pictures of me during this event and agree for this event to use any
photos of me that may be taken during my participation. I grant permission to publish my name in the results of this event. I also grant permission for event's organizers to use my email address to communicate with me concerning other upcoming events and specifically, instructions for this event. I will abide by these guidelines. GUARDIAN’S PERMISSION AND RELEASE FOR MINOR: If I am or will be applying for my child to participate in,
or be a volunteer at, this event, 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 this event and I agree that the terms of this Waiver Releases, and Authorizations apply equally to my child and me and any claims I or my child may have in connection with this event. I also waive any derivative claims that relate to or arise out of my child’s participation in this event.
AGREEMENT: Having read the waiver including the acknowledgement, authorization and permission and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release 1st Place Sports, Inc,, 1st Place Sports Running Club, Inc, 1st Place Sports Management Services, Inc , the City of Jacksonville, its agencies departments and officials; any other Organizers of this
event, all charitable beneficiaries of this event, all sponsors of this event, and their licensees, sponsors, employees, official, volunteers, including medical volunteers, and other representatives, agents, and successors of each of the foregoing, from present and future claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons or
organizations named in this waiver.
Please sign here. (Parent must sign if participant is under 18 years of age)
Date Signed