RegistrationForm - Williston Runs for Education

5K Race / Walk and Kids Fun Run
Saturday, May 16, 2015, 9:30 AM
Sponsored by Williston Families as
Partners (FAP). Proceeds fund
programs to benefit Williston students
and teachers.
Presented by:
Race Location: Williston Central School, 195 Central School Dr., Williston
• 8:00 - 9:15am - Race day registration & packet pickup
• 9:30 am
– Kids Fun Run Start
• 10:00 am
– 5K start (Walkers start after runners)
• 11:00 am
- Awards ceremony, raffle prize drawing & entertainment
• 12:00 pm
- Event concludes
5K Age Groups: Male/Female - 14 & under,
15-19, 20-29, 30-39, 40-49, 50-59, 60-69,
70+.
Awards & Prizes: Awards to 5K male & female
age group winners, team awards, and raffle prize
drawing.
Course Description: There are two distance options for the Kids Fun Run (1 Loop
Results: Final race times will be listed in the
or 2 Loops) around the gravel track behind Williston Central. The 5K course
Williston Observer, School Bell and on the Williston
starts on the bike path and finishes behind Williston Central School. For a
Runs for Education website at willistonruns.org.
detailed 5K course description go to www.willistonruns.org.
Save time - register online at www.willistonruns.org
Register by May 11
and be automatically
entered into the preregistered prize
drawing!
or complete one form per participant
Return completed forms with payment to the Main Office at Williston Central or
Allen Brook School or mail to:
Williston Runs! c/o FAP, 195 Central School Dr., Williston, VT 05495
Name: _____________________________________________________________ Phone: ___________________________________
E-mail: _____________________________________________________ Age on race day: ______________ ☐ Male ☐ Female
Individual Entry (select one):
☐ 5K Run
☐ 5K Walk
☐ Kids Fun Run 1 Loop (1/3rd mile)
☐ Kids Fun Run 2 Loops (2/3rd mile)
Anyone covering the course on a bike, scooter,
skateboard, rollerblades etc., MUST WEAR A
HELMET TO PARTICIPATE!
5K Run - 3 Person Team Entry: (Note: no race-day registration for teams)
Team Name: ________________________________________________
Captain’s Name: ____________________________________________
Team Member Names:_______________________________________
_____________________________________________________________
Team Type:
☐ Family
☐ School
☐ Business/Sponsor
☐ Other
Entry Fee:
Kids/Students 13 and younger - $7.00 ($10 day of race) $ __________
Adults - $12.00 ($15 day of race) $ __________
3 Person Teams ($10 each member) $ __________
Raffle:
All registered participants
automatically receive 1 raffle ticket.
You may purchase additional
tickets for a better chance to win
cool prizes!
EVENT CONTACT:
Sue Scheer
238-2474
[email protected]
1 ticket ($1.00) $__________
6 tickets ($5.00) $__________
10 tickets ($7.00) $__________
THANK YOU for
supporting
education!
TOTAL: (please make checks payable to “Williston FAP:) $__________
Athlete Waiver and Release of Liability/ Photo Release – Must be signed to participate
I know that walking/running/riding in a race is a potentially hazardous activity and that I should not walk/run/ride unless I am medically able and properly trained. I
assume all the risks associated with walking/running/riding in this event. Having read this waiver 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 the Town of Williston, Williston Central School, Allen Brook School and the Williston
FAP, and all sponsors, their representatives and successors, for all claims or liabilities of any kind arising out of my participation in the Williston Runs for Education
event. grant permission to be photographed, video taped and recorded for all media usage.
Participant Signature : __________________________________________________________________ Date: __________________
(Parent/Guardian must sign if participant is under age 18)