hard-copy registration form

ROCK FOR HOCKEY
5K
Saturday, June 20th
West Chester, PA
7:00 AM Race Day Registration at Side Bar
8:15 AM 5K Road Race
9:30-noon: Side Bar Post-Race Party
Cost: Checks should be made payable to “Rock for Hockey”
Pre-Registration
$25.00
Race Day Registration $30.00
Course:
Race starts on Church and Market Street, then finishes just past New and Market Street.
Contact Info: Brent Jones
610-368-7344 or [email protected]
Registration: Pre-register online at www.runCCRS.com
Or mail your
Rock for Hockey
registration to:
PO Box 56
Uwchland, PA 19480
Awards:
$50 Prize - Top Male and Female Overall
$25 Prizes - Age Groups (14 & Under, 15-19, 20-29, 30-39, 40-49, 50-59, 60+)
Amenities:
T-shirts guaranteed to all participants registered by 6/6/2015. All others will receive a t-shirt while
supplies last. All participants will receive a Rock for Hockey window sticker.
Results will be posted live at www.runccrs.com
Join us at Side Bar’s Post-Race Party!
Benefits:
A portion of the proceeds from this race benefits the Rock for Hockey Organization, a 501(c)3 nonprofit organization dedicated to providing material support to hockey players in the mid-Atlantic
region that demonstrate a need for assistance in order to continue playing the game.
Event Times:
ROCK FOR HOCKEY 5K
NAME:
EMAIL:
GENDER:
MALE
FEMALE
T-SHIRT:
SM
MED
Waiver:
AGE:
LG
XL
XXL
In consideration of the acceptance my entry, I, intending to be legally bound, do hereby for myself and my heirs, executors, administrators waive and release any and
all rights and claims for damages I may accrue against the persons and organizations affiliated with the race including but not limited to the Chester County Running
Store, CK Timing, Rock For Hockey, Side Bar Restaurant, all sponsors, volunteers, staff, subcontractors, agents, attorneys and representatives for any and all injuries
that I may suffer while participating in the event or en route to and from the event. I consent to the use of my image in photos, videos and audio recording and film, of
my participation in the event. I attest that I am physically fit and sufficiently trained for this competition, my physical condition verified by a licensed M.D. during the last
6 months. As part of the waiver, I acknowledge that I have read and understand all of the above. NO REFUNDS. The participant understands that the entry fee is nonrefundable and non-transferable (unless specifically stated on the online registration form). The participant also understands that the Event will take place rain or shine,
at Race Director's discretion. The Race may also be canceled due to natural hazards or other factors not under the control of the Race Director. If race is cancelled for
any reason, there are no refunds.
Signature:
Guardian Signature if Under 18: