Registration Form Front - Cross Keys Community Park

Transcription

Registration Form Front - Cross Keys Community Park
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Our Second Year!
April 25, 2015
www.ckpark.org/5k
For More Info or to Register Online
SATURDAY
APRIL 25, 2015
RACE START TIME: 8:30 AM
AT CROSS KEYS COMMUNITY PARK
785 BERLIN ROAD, NEW OXFORD, PA
RACE DAY REGISTRATION BEGINS AT 7:30 AM
SPREAD THE WORD!
REGISTRATION FEE:
$20 Individual ($25 late registration, day of race)
$25 Individual plus 1 dog
$10 Cat Nappers Club
We cordially invite you to participate in the 2nd annual
Bark in the Park 5K to help support the Cross Keys
Community Park development project. This event will
raise needed resources to help in funding Phase II of the
park construction, specifically a designated dog park
facility. Cross Keys Community Park is a local, non-profit
organization with a goal to positively impact the
community by creating recreational, environmental and
educational opportunities. The event will begin at 8:30AM
with prizes given for top qualifiers in each age group.
Dog owners can register their pets to participate, as well.
Locally Sponsored By:
Without the generous support of these businesses this event could not take place!
Your Logo will be placed
here, on the official registration
form with other sponsors
and other promotional
items as well!
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Our Second Year!
April 25, 2015
at Cross Keys Community Park, New Oxford, PA
Registration Form
SATURDAY, APRIL 25, 2015
RACE START TIME: 8:30 AM
REGISTRATION BEGINS AT 7:30 AM
Name: _____________________________________________________
E-Mail Address: ____________________________________________
Phone Number: _____________________________________________
Address: ___________________________________________________
City: __________________________ State: _______ Zip: ___________
Sex (circle one): Male
Female
Age on Race Day: ________
Registration Fees:
Amount Paid: $ __________
$20 Individual ($25 after April 14, 2015)
$25 Individual plus 1 dog
$10 Cat Nappers Club (T Shirt Only- Non-Participant)
T-shirt size (circle one):
Adult
S M L
Child
S M L
Prizes will be awarded to 1st, 2nd and 3rd place male and female finishers in each
age group. Age groups are as follows: 12 and under, 13-18 yrs., 19-29 yrs., 30-39
yrs., 40+. Every participating dog receives a bandana and treat at the finish line.
XL
I decline a T-shirt (Please allow my
full race registration to go to Cross
Keys Community Park )
Race Route: The Bark in the Park 5K will be an all-road course that starts and finishes at Cross Keys Community Park (785 Berlin
Rd, New Oxford, PA). Mile markers, signs and volunteers will guide racers.
Please list any allergies: _____________________________________________________________________________________________
Please list any health concerns or conditions: __________________________________________________________________________
Please check to indicate understanding:
Liability Waiver and Photo Release: In consideration of acceptance of this entry to the Bark in the Park 5K Race, I waive all claims for myself, heirs, and assigns against
the sponsors, cooperating groups, and/or any individual associated with the event, and will hold them harmless of any and all injuries or illnesses that may result from
my participation. I further state that I am in proper physical condition to participate in this event. I also hereby give my permission to use my name and/or photo in any
media coverage without obligation to compensate me.
Race Rules:
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Participants must stay on the race course
Registration Fee is Non-Refundable
Bib Number must be placed on the FRONT of your shirt
All participants MUST be in line by 8:20 am
Walkers, children, participants with dogs will begin behind runners
Participants must follow instructions of course officials/volunteers
Only registered runners/walkers are permitted to participate
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MP3, iPod and other music devices are strongly discouraged
Prizes will be announced immediately after the completion of race
All dogs must be leashed (no flex leashes)
No aggressive dogs
1 dog per participant
Must present proof of vaccination upon registration
Must clean after your own pet
Signature: _____________________________________________________________________________
Date: ___________________
* Please make checks payable to Cross Keys Community Park and send form and fee to Cross Keys Community Park, Attn: Brita Byers, 785
Berlin Rd, New Oxford, PA 17350. Questions or concerns may be directed to Brita Byers or Tracy Miller at 717.624.8660. Pre-race
registration is DUE BY April 14, 2015 to be guaranteed a t-shirt. Race day registration will be $25 for all applicants, registration opens
at 7:30am and closes at 8:15am. Race day registrants are not guaranteed a t-shirt.