2015 5K Run/Walk Appliaction
Transcription
2015 5K Run/Walk Appliaction
4th Annual Chatfield College 5K RUN/WALK & Mini Health Fair Saturday, July 18th, 2015 20918 State Route 251, St. Martin, OH 45118 Registration/Check-in: 8:00 am | 5K Run starts: 9:00 am | 5K Walk starts: 9:01 am Please fill out a separate form for each participant. _____________________________________________________________________________ First Name (Please Print) Last Name □ Male □ Female _____________________________________________________________________________________________ Address _____________________________________________________________________________________________ City/State/Zip Phone # Email I will be participating in the: □ 5K Run □ 5K Walk T-shirt Size (check one): □ Under 13 □14-19 □20-29 □30-39 □40-49 □50-59 □60-69 □Over 70 □ Under 30 □30-49 □50-69 □Over 70 □ S □M □L □XL □2XL Registration Fees Registration fee includes race entry, T-shirt, and post-race refreshments. Note: Those registering onsite June 20th are not guaranteed a shirt or correct size. Adults (over 18) $15 Students and Children $8 Optional additional donation gladly accepted. $______________ Amount Enclosed Pre-Registration To be pre-registered your completed registration form must be postmarked by Saturday, June 13, 2015. Make checks payable to: Chatfield College Mail registration form/checks to: Chatfield College 5K Attn: Brianna Houchens 20918 State Route 251 St. Martin, OH 45118 Awards Directly following the race, a trophy will be awarded to the overall winner. Medals will be awarded to top finishers within each division. Waiver and Release Statement (All participants must read and sign) I understand that participating in this event will subject me to potentially dangerous conditions, including uneven terrain, potentially warm temperatures, and other runners/walkers who may cause falls or other injuries. I certify that I am in proper physical condition to participate in this event and hereby release and hold harmless Chatfield College and its volunteers from any and all demands, claims, damages, or suits arising from or relating to bodily injury or personal property loss or damage sustained by me, or property damage or bodily injury to others caused by me during or because of participation in this event. I agree to follow all rules set forth for this event. I further grant full permission to Chatfield College to use any photographs of the event for any reasonable purpose. ___________________________________________________________________________________________ Signature of Participant (or signature of Parent/Guardian if participant is age 17 or under) Date ___________________________________________________________________________________________ Printed Name of Participant or Parent/Guardian