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 –

[pic]

5K Run/Walk

For individuals and Teams

Kids Fun Run - Free

For 8yrs and younger

[pic]

Fun and

Prizes, Prizes, Prizes!

For Questions call:

First Christian Church 317-398-4407

Proceeds Benefit:

[pic]

Furthering First Christian Church’s commitment to promoting health and wellness in our community

First Christian Church

Shelbyville, Indiana

Health and Wellness Committee

[pic]

6th Annual

[pic]

[pic]

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

[pic]

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.

[pic]

(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.

-----------------------

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

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download