File - Tecumseh, Nebraska

Race Route
TSCI
WELLNESS
“JUST FOR THE HEALTH OF IT”
TECUMSEH STATE
CORRECTIONAL
INSTITUTION
The TSCI
Wellness Committee
Presents
BREAK OUT!
APRIL 11, 2015
The 4th Annual
TSCI Prison
Break 5K
Fun Run/Walk
Mark Rumery
Tecumseh State Correctional Institution
PO Box 900
Tecumseh, NE 68450
Registration held at the
The First Baptist Church
Phone: 402-335-5114
E-mail: [email protected]
April 11, 2015 @ 8:00 am
Registration at 7:00 am
The First Baptist Church
Activity Center— 333 Jackson
REGISTRATION FORM
The TSCI Wellness
Price List
Name:
Committee
The TSCI Wellness Committee
works towards creating health
awareness and empowering the
staff of TSCI and their
families to make healthy life
choices. The Committee
provides information, hosts
healthy option food days and
facilitates activities to get
people involved in healthy
activities. The TSCI Prison
Break 5K is another
opportunity for the Wellness
Committee to help people
continue their work towards
maintaining a healthy lifestyle
and have fun doing it!
TSCI’s Prison Break 5K
_______________________________
Address: _____________________________
_____________________________
_____________________________
Entry Fee $20 (if paid by March 13th)
$25 (After March 13th / day of the race)
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Early Participants will receive a tshirt and gift bag upon registration.
Prizes for the overall male and
female winner will be awarded.
Door prizes will also be given out
through random drawing of
participants.

Registration will start at 7:00 am in
The First Baptist Church Activity
Center- 333 Jackson St

A reception area with drinks and
snacks will be setup following the
race.
Phone: _____________________________
Email:
______________________________
Date of Birth: ____________ Age: _______ Gender: ______
Adult T-Shirt Size S M L XL XXL Other ________
Youth T-Shirt Size XS 2-4 / S 6-8 / M 10-12 / L 14-16
Other ____________
T-Shirts are not guaranteed for those that do not submit entry prior to March 13th
Race will be held regardless of weather conditions. Registration is final.
No refunds.
Waiver: In consideration of the acceptance of this entry, I, the
undersigned, assume full and complete responsibility for any
injury or accident which may happen to me during the event
know as the TSCI Prison Break 5K, and I hereby release and
agree to indemnify, defend, and hold harmless the City of
Tecumseh, sponsors, promoters, and all other persons or
entities associated with this event from all injuries and
damages, or otherwise. I grant permission to all of the
foregoing to use any photographs, motion pictures, recordings,
Return the entry form and fee to
Mark Rumery
Tecumseh State Correctional Institution
PO Box 900
Tecumseh, NE 68450
Phone: 402-335-5114
E-mail: [email protected]