registration 2015 and waiver form

8th Annual Deer Dash 5K
& 1-Mile Fun Run
Saturday, May 16, 2015
Deer Crossing Elementary School
10601 Finn Drive
New Market, MD 2177410
Benefits the Deer Crossing Elementary School PTA.
Packet Pick-Up and On-Site Registration:
Friday, May 15
3:30—7:00 pm
Saturday, May 16
7:30—8:15 am
Race Day Schedule:
5K Run/Walk
1-Mile Fun Run
Awards
**Register by April 30th to
be Guaranteed a T-Shirt!**
8:30 am
9:30 am
10:00 am
— — — — — — — — — — — — — One form per family please — — — — — — — — — — — — —
ENTRY FEES
By 4/30
After 4/30
Adult (12 and up)
$25
$30
DCES Staff
$10
$10
Student
$15
$15
Family*
$55
$60
Family Sponsor**
$100
$100
* Includes related children and up to 2 adults
** Family registration with name on race T-shirt if received by 4/30
Participant Name (s)
*Shirt Sizing Chart:
Youth : XS (4), S (6/8), M(10/12), L (14/16), XL (18/20)
Men's: XS, S, M, L, XL, 2XL, 3XL, 4XL
How to Register:
1. Online at imathlete.com/events/deerdash5k
no later than May 13, 2015.
2. Fill out and return this form to DCES.
(make checks payable to DCES PTA.)
3.
At Packet Pick-Up on Friday, May 15th or
Saturday, May 16th.
Age
Grade
Level/
Stroller
Gender
(M/F)
5K,
Fun Run
or Both
Fee
Women's: XS (2), S (4/6), M (8/10), L (12/14), XL (16/18), XXL (20/22), 3XL (24/26), 4XL (28/30)
Address
Phone
Shirt Size
(see chart
below)
TOTAL:
TOTAL:
Email Address
Family Sponsors: Please enter the name exactly as you would like it to appear on the T-Shirt:
__________________________________________________________________________________________________
*Stroller Runners* The child in the stroller will receive a T-Shirt, but will not receive a bib.
Are you planning to participate in the Spring Challenge? ____ Yes ____ No
If Yes, how many in group will participate? _______
Release: I the undersigned participant, intending to be legally bound, do hereby for myself and heirs, executors, administrators and assigns, forever waive, release and discharge any
and all rights, claims and actions for damages that I may have, or that may hereafter accrue to me against the Maryland PTA including all units and councils, and all of their officers,
directors, members and volunteers. I attest and verify that I am physically fit and able to participate in this event and acknowledge that I am aware of the inherent risks in participating in
an athletic event of this type. Further, I grant permission for the use of any photograph or recording of this event for legitimate purposes.
____________________________________________
Participant Printed Name
________________________________________________
Signature
_________________
Date
If participant is under the age of 18:
I am the legal guardian of Participant and hereby consent to his/her participation. I have read the foregoing release and agree on behalf of myself and the Participant to its terms.
____________________________________________
Parent/Guardian’s Printed Name
________________________________________________
Signature
_________________
Date