May 2 , 2015 Berkshire 5K - Berkshire Middle School Proud Dads Club

May 2nd, 2015
7th Annual
Berkshire 5K
0
Registration Form
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Berkshire Middle School
21707 West Fourteen Mile Road
Beverly Hills, MI 48025
Sponsored by the Proud Dads
club
http://berkshiremiddleschool.webs.com
Awards
Overall, Masters M & F, Age groups: 10
& under, 11, 12, 13, 14, 15-19, 20-24,
25-29, 30-34, 35-39, 40-44, 45-49, 5054, 55-59, 60 & up
Course:
5K loop. Through scenic Beverly
Hills. Fast course!
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Packet pick-up and race day registration opens at 7:00am

Professional timing by Everal Race Management

T-shirt and post-race refreshments provided
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Online registration powered by Active.com
Registration – no refunds
EARLY BIRD - $15 before April 8th
$20 before May 1st
$25 race day
Proceeds go to the Proud Dad’s Service Project(s)
Make Check Payable to: Berkshire Middle School
Name:
Address:
City:
Date of Birth:
e-mail:
State:
Male:
Female:
Age on May 2, 2015:
Zip Code:
Phone:
Shirt Size: S M L XL
WAIVER: To be signed by athlete/guardian if athlete is under 18. Running a road race involves risks of serious injury. Potholes and other surface defects exist in the
course. Motorists, cyclists, pedestrians and animals may accidentally or deliberately create hazards. Also, the physical strain of a long distance race can lead to serious
health problems. I have read and understand this statement and agree to assume all risks of personal injury or other physical or emotional ailments I may incur from
participating in this event. I hereby Release, Waive and Covenant Not to Sue, and further agree to Indemnify, Defend and Hold Harmless the following parties: USA
Track & Field, Village of Beverly Hills, Birmingham Public School District, Berkshire Middle School, Berkshire PTA, Berkshire Proud Dads club, Race Directors, and the
beneficiaries and sponsors from any injuries and ailments I may incur from participating in this event. Further, I hereby grant full permission to any and all of the
foregoing to use any photographs, videotapes, motion pictures, recordings, or any other record of this event for any legitimate purpose.
Signature & Date:
A parent or guardian must sign for all participants under 18.
Emergency Contact:
Emergency Contact Phone:
Mail Entry Form to: Berkshire Proud Dads’ 5K - 21707 West Fourteen Mile Road Beverly Hills, MI 48025