RACE PARTICIPANT AGREEMENT:
This Goal of the Grace Race 5K and Kids Fun Run is to have a fun, safe, greater community event that raises funds for the Shelby Community Health Center. The Grace Race 5K and Kids Fun Run wants everyone to –
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5K Run/Walk
For individuals and Teams
Kids Fun Run - Free
For 8yrs and younger
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Fun and
Prizes, Prizes, Prizes!
For Questions call:
First Christian Church 317-398-4407
Proceeds Benefit:
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Furthering First Christian Church’s commitment to promoting health and wellness in our community
First Christian Church
Shelbyville, Indiana
Health and Wellness Committee
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6th Annual
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First Christian Church, Shelbyville, IN
118 West Washington St.
Shelbyville, IN 46176
[pic]Like us on facebook
Grace Race 5K Run/Walk and Kids Fun Run
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when: Saturday, October 5, 2013
Registration opens at 7:00 am
Kids Fun Run begins at 8:00 am
Run / Walk begins at 8:15 am
where: First Christian Church
118 W. Washington Street
Shelbyville, Indiana
why: To raise funds for Shelby Community Health Center and promote health and wellness in our community
rates: Individuals
$25 before Friday, Sept. 13, 2013
$30 after Friday, Sept. 13, 2013
Teams of Five (5)
$100 before Friday, Sept. 13, 2013
$125 after Friday, Sept. 13, 2013
T-Shirt opt out – Check box on form and save $5/ person.
Kids Fun Run (8yrs and younger)
Free with T- shirt before Friday, Sept. 13
Free, no guarantee of shirt after Sept.13
prizes: Overall male & female finishers, Masters winner (over 60 yrs), Team winners and RaNDoM PriZeS !!!
Anyone can be a winner!
extras: Activities for children during the 5K. Refreshments served post-race.
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(Photocopies welcome)
Please Circle Event:
5K Run / 5K Walk / Free Kids Fun Run
Name: _____________________________
Team Name (if applicable): _____________________________
*Each team member must complete a separate entry form. Return all four entries together with one team entry fee.
Address: _____________________________
City:__________________________
State:_______ Zip: ______________ Phone:________________________
Sex: Male Female
Age on race day: _________________
Emergency Contact: _____________________________
Phone: ___________________________
5K Shirt Size(circle): S M L XL XXL
Kids Fun Run Shirt size: YS YM YL
Fee -- Check one
[ ] $25 5K before Sept. 13
[ ] $30 5K after Sept.13
[ ] $125 Team of Five Runners submitted with five forms and waivers
[ ] Free Kids Fun Run before Sept. 13 withT-shirt
[ ] Free Kids Fun Run after Sept. 13 – no guarantee of T-shirt
[ ] Extra Donation $______________
[ ] T-shirt Opt out. Subtract $5 per individual.
Total Donation $__________________
Waiver/Release
Must submit with Entry Form for each participant
RACE PARTICIPANT AGREEMENT:
In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for any claims damages I may have against any of the sponsors, organizers, First Christian Church and the City of Shelbyville , for any and all claims of damages, demands or loss actions whatsoever which may arise as a result of my participation in this event. I understand and acknowledge that participating in this run/walk event may expose me to dangers from both known and anticipated risks. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.
Signature: _______________________
Printed: _________________________
Signature of Parent or Guardian (if under 18):
_________________________________
Date: ____________________
Thank you for completing this form for each participant. Please send it to:
First Christian Church
118 W. Washington Street
Shelbyville, IN 46176
Remember to enclose payment for the Total Donation
We will see you October 5, 2013 for a Fun Event!!
First Christian Church reserves the right to cancel, delay, or adjust the time of the event due to severe weather. No refunds.
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Saturday
October 5, 2013
Kids Fun Run 8:00 am
5KRun/Walk 8:15 am
Directions to race:
From Indy: Follow I-74E to 1st Shelbyville exit (113).
Right on State Road 9, to Public Square. Right on West Washington Street, past City Hall.
Let us run with endurance, the race that is set before us.
– Hebrews 12:1
Get the whole family and all your friends involved.
Together we make a difference
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