to Print the Paper Registration

Start/Finish LIne Sponsor
St. PeterDASH
MEN FOR TOMORROW. 5K Run/Walk
Kids ¼ mile Fun Run
Saturday, June 1, 2013
Date/Time: Location: Registration:
Shirts: Courses: Bib Numbers:
Timing: Awards:
BROTHERS FOR LIFE
June 1, 2013 5K run/walk start at 7:30 am. Kids Fun Run (ages 7 & under) starts at 8:45 am.
St. Peter Catholic School in Kirkwood at the corner of W. Jefferson Ave. and N.Clay Ave
Registration by May 20: $20, Children 5-14 $10. Late or Race Day registration is $5 more
per participant. Family of 4 is $50 prior to May 18, or $60 for Late or Race Day Registration
$5 for each additional child regardless of early or late registration Family registration must be
done with paper form--no online. Individual registration may be done by paper form OR
at: www.stpeterkirkwood.org (a service fee will be added for online registration)
All registrants prior to 5/20 will receive a short sleeve cotton tee; on or after 5/20 1st come basis
Dri-fit shirts available for additional $15
The 5K (3.1 miles) is through the scenic neighborhood streets of downtown Kirkwood.Course
map available online at www.stpeterkirkwood.org Kids Fun Run is 1/4 of a mile.
Only runners will have official run times recorded and published. If you would like to have
your time recorded you must register as a runner. Walkers will not be officially timed.
Big River Running Company will provide professional timing: www.bigriverrunning.com
Awards will be given to 1st, 2nd, 3rd place male & female overall winners, and top finishers in
the following age categories: 14 & under, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+.
All children 11 and under will receive an award of participation.
Charity: All proceeds will benefit St. Peter Catholic School.
Packet Pick-up: Friday, May 31st (4pm-7pm) and Saturday, June 1 (6am-7:15am)
St. Peter Catholic School, 215 N.Clay Ave., Kirkwood, MO 63122
Join Us for a Finish Line Party!
food, beverage and entertainment will be provided
for additional information:[email protected]
Kids Fun
Run
Sponsor
Gold Sponsors
Bronze Sponsors
Commerce Bank · Keane Insurance
Pediatric Dentistry of Sunset Hills
Renaissance Financial ·
Husch Blackwell
CommunitySponsors
Desco Floors
· Kertz Law Firm
Crossfit Kirkwood
· Riggin Law Firm
_____________________________________________________________________________________________________________
· Paper Dolls
Mailed entries must be post marked by May 20 to qualify for early registration Bopp Chapel
Great Harvest Bread Co.
Make all checks payable to St. Peter PTOGreensfelder Law
Mail to: St. Peter Catholic School, 215 N. Clay Ave, Kirkwood, MO 63122
Hot Mamas in Training · Lockton Insurance
#1 Name:
_____________________________________________________________________________
Combs Tire & Auto
· Roberts Fine Apparel
Last
First
Gender
Age on 6-2-13 Ursuline Academy
· Billy G’s
Address:
_____________________________________________________________________________
Nerinx Hall
·Lou Fusz
Street
City
State
Einstein Bagel
· St. Joseph’s Academy
_____________________________________________________________________________
Fun in the Sun Sports · Chill Frozen Yogurt
Zip
phone number
e-mail
St. Louis Pipe & Supply
Carole Bernsen, Coldwell Banker Gundaker
I’ll be participating in the following (circle one): 5K Run
5K Walk
Kids Fun Run 7 & under
California Custom Decks
Preferred Shirt Size (circle one): Youth: S M L Adult: S M L XL XXL Women’s Fit: S M L XL
Dri-Fit Shirt $15.00 each
Adult: S M L XL Womens: S M L XL
#2 Name______________________________________________ gender___________ age on 6-2-13________
I’ll be participating in the following (circle one): 5K run
5K Walk
Kids Fun Run 7 & under
Preferred Shirt Size (circle one): Youth: S M L Adult: S M L XL XXL Women’s Fit: S M L XL
Dri-Fit Shirt $15.00 each
Adult: S M L XL Womens: S M L XL
#3 Name: _____________________________________________ gender__________ age on 6-2-13___________
I’ll be participating in the following (circle one): 5K Run
5K Walk
Kids Fun Run 7 & under
Preferred Shirt Size (circle one): Youth: S M L Adult: S M L XL XXL Women’s Fit: S M L XL
Dri-Fit Shirt $15.00 each
Adult: S M L XL Womens: S M L XL
#4 Name: _____________________________________________ gender___________ age on 6-2-13____________
I’ll be participating in the following (circle one) : 5K Run
5K Walk
Kids Fun Run 7 & under
Preferred Shirt Size (circle one): Youth: S M L Adult: S M L XL XXL Women’s Fit: S M L XL
Dri-Fit Shirt $15.00 each
Adult: S M L XL Womens: S M L XL
Participant(s) Signature
_____________________________
(or Guardian’s Signature) ____________________________
____________________________
____________________________
Fees:
Individuals
by 05/20/13
$20
Late/Race Day $25
Children 5-14
by 05/20/13
$10
Late/Race Day $15
Family of 4
by 05/20/13
$50
$5 for each additional child
(early or late registration)
Late/Race Day $60
Dri-Fit Shirt
$15
Date: _____________
I am unable to participate but
would like to sponsor a
runner by donating $_______
for the school fundraiser.This
donation is tax deductible
Release for Participation: In consideration or your accepting either me or my child’s entry, I hereby, for myself, my children, my heirs, executors and administrators, waive and release any and all
rights and claims I or my child may have against St. Peter Catholic Church and School, the City of Kirkwood, any and all sponsors or contractors, their representatives, successors and assigns for
any and all injuries suffered during the activity stated above. I understand that such activities are potentially dangerous, and that injuries or even death can occur.