Registration Form - Schoharie 5K Run

Schoharie 5K Run/Walk April 18th 2015
Presented by S’cary Leg Runners and Schoharie Valley Teachers Association
Benefits : - “Schoharie Community Pool”.
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April 18th, 2015 - 10 AM - Schoharie Elementary School
Performance Technical Tee shirts for the first 300 Registered!
Packet Pickup & Day of Registrations starting at 9AM
Kids Fun Run – (register on race day 4-18-15) put on by EPTSO
Awards for the top male & female finisher overall & for the first 3 male & female in each age
group: 9 & under, 10-14, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
Walker Awards for 1st Place in each age group
Course is USAFT certified – Certification Code NY12022JG
Active.com link - https://endurancecui.active.com/event-reg/select-race?e=12409552
Mail Registration Form and Non-Refundable Entry Fee to:
Schoharie 5k Run
Make checks payable to: S’cary Leg Runners
521 Rickard Hill Rd For Race Info, Course maps and additional registrations forms go to: www.sta5k.org
Schoharie NY 12157 For more information contact: [email protected] or 315-427-3856
First Name
Last Name
Street address
City
State
Zip
Phone
Email
S
T-shirt size (circle one)
M
L
XL
XXL
Event (circle one)
Run
Walk
Age
Date of Birth
Sex
Students - Grades 12 and under
$10 Students early registration by 3-31-2015
$15 Students registration 4-1 until day of race
$20 Adult early registration by 3-31-2015
$25 Adult registration 4-1 until day of race
Total $ Enclosed
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Signature
Date
Signature of Parent or Guardian if under 18 Date
In consideration of accepting this entry, I, the undersigned, intending to be legally bound hereby, for myself, my heirs, executors and administrators,
waive and release any and all rights and claims for damages I might have against the Schoharie Teachers Association, S’cary Leg Runners, the
Village of Schoharie, State of New York, NYS DOT, any officials or sponsors of the race, their representatives, assessors, and assigns, for all
injuries, illness or property loss suffered by me while competing in or traveling to or from this race. I attest and verify that I am physically fit and
have sufficiently trained for completion of this race.
REGISTRATION FEES ARE NON-REFUNDABLE