Registration

Registration
Please make checks payable to The Montessori Academy
Return Registration and Payment to The Montessori Academy
530 E Day Rd, Mishawaka IN 46545
(p)574-256-5313 (f)574-256-5493
www.AnEducationForLife.com
First Name: _________________________________________________________
Last Name: _________________________________________________________
Email: _____________________________________________________________
Address: ___________________________________________________________
City: _______________________________________________________________
State: _______ Zip: ___________________ Phone: _________________________
DOB: ___/_____/_____ Age on Race Day: _________ Gender:
M
F
Event:
10K ($30 through July 31 / $33 Aug 1-Oct 17 / $38 Race Day Registration)
5K ($25 through July 31 / $28 Aug 1-Oct 17 / $33 Race Day Registration)
2K ($25 through July 31 / $28 Aug 1-Oct 17 / $33 Race Day Registration)
Children’s Obstacle Course ($15 through Oct 17 / $20 Race Day Registration)
T Shirts are only guaranteed to those who register by Oct 1.
Please select your size preference.
○Adult S ○Ault M ○Adult L ○Adult XL ○Youth S ○Youth M ○Youth L
Or...
Register
online by
scanning
this handy
QR code
with your
smart
phone!
—————————Waiver of Liability—————————
*Signature Required (parent/guardian if under 18)*
I know that running in the Fall Frolic 10K,5K, 2K Fun Run and Kids Obstacle Course is potentially
hazardous activity. I should not enter and run unless I am medically able and properly trained. I
agree to abide by any decision of a race official relative to my ability to safely complete the run. I
assume all risks associated with running in this race including, but not limited to falls, contact with
other participants, the effects of the weather, including extreme cold or high heat and/or humidity, traffic, and the conditions of the road. All such risks are known and appreciated by me. Having
read this waiver and knowing the facts in consideration of your accepting my application. I, for
myself and anyone entitled to act on my behalf waive and release The Montessori Academy at
Edison Lakes, Center for the Homeless, its sponsors, its volunteers, race directors, and successors
from all 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 named in this
waiver. I grant permission to all the forgoing to use any photographs, motions picture, recordings,
or any other record of this event for any legitimate purpose. All persons under 18 years of age
must have written consent of parent/guardian to compete in the above mentioned events. The
above signed parent/guardian hereby consent to the applicant's participation and waive and
release rights and claims for damages as is more fully set forth above.
Signature: _________________________________________________ Date: ________________