Gloucester County Educational Foundation VIRTUAL 5K ...

[Pages:1]Gloucester County Educational Foundation Chesapeake Bank and

Chesapeake Wealth Management

WEALTH MANAGEMENT

VIRTUAL 5K Run/Walk

MARCH 20-APRIL 10, 2021

VIRTUAL 5K DETAILS Cover your 5K (3.1 miles) wherever and whenever you would like between March 20 and April 10, 2W0E2AL1T.H MANAGEMENT

REGISTRATION

Registration ends on April 1, 2021:

Register either by completing and sending in this paper registration form or online at gcef5k.

Early Registration on or before March 5:

If you would like to pick up your race packet before the race window begins, you must register on or before March 5.

AWARDS

e Ann Burruss Memorial Awards will be given for:

? e oldest and youngest M/F nishers

? e middle-of-the-pack nisher

Recipients of these awards will be noti ed by email the week of April 11, 2021.

RACE CONTACTS Carol Dehoux, (804) 693-1425 GCPSEDFOUND@gc.k12.va.us

Mike Jenkins, (804) 824-4146 mickj1@

Gloucester Schools Participants:

Paper registrations must be received by April 1. Submit registrations to any Gloucester School o ce or mail to address below. Please allow at least one week if mailing.

T-SHIRTS: Short-sleeved T-shirts are available wtih Deluxe or Deluxe Student registration.

PROCEEDS Proceeds help to fund educational endeavors in Gloucester County Public Schools, including the annual Mini-grants and Teacher of the Year programs.

For more info, visit .

MAIL TO Carol Dehoux GCEF 6099 T.C. Walker Road Gloucester, VA 23061

RESULTS Will be tabulated and published by the Peninsula Track Club.

RACE REGISTRATION

FIRST NAME ______________________________ LAST NAME _____________________________________

STREET ADDRESS

ENTRY FEES

CITY ___________________________________ STATE _____ ZIP_________ PTC MEMBER: Y N $15--Students K-12

AGE ON RACE DAY _________ DATE OF BIRTH ___/___/___

GENDER: MALE FEMALE

includes finisher's medal

$25--Deluxe Students K-12

T-SHIRT SIZE (Check one) Youth: S M L

Adult: S M L XL XXL ($2 extra)

includes finisher's medal

EMAIL ADDRESS: ____________________________________ PHONE (_______)________________ (Including your email address will ensure that you receive timely race updates.)

and T-shirt

$20--General Registration includes finisher's medal

If applicable, please indicate the Gloucester County Public School you are running/walking for: _________________________________________________________ (This is not a requirement.)

$30--Deluxe Registration includes finisher's medal and T-shirt

RELEASE AND WAIVER: I know that participating in a race is a potentially hazardous activity. I should not enter and run/walk unless I am medically able and properly trained. I assume all risks associated with participating in this event, including, but not limited to, falls, contact with other partic-

XXL shirt (add $2.00)

ipants, the e ects of weather, including, high heat or humidity, tra c and the conditions of the road, all such risks being known and appreciated by Donation me. Having read this waiver and knowing these facts, and in consideration of accepting my entry, I for myself and anyone entitled to act on my behalf,

waive and release the Gloucester County Public Schools Educational Foundation, Gloucester County Public Schools, all sponsors, their representatives Total Amount Enclosed and successors from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use

any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. I further agree to abide by the Center for Disease Control's (CDC) recommendations for the prevention of the spread of the 2019 Novel Coronavirus Disease (COVID-19) and other communicable diseases, and I attest to having read the CDC's guidance at: . I assume all

Make checks payable to GCPS Ed. Foundation

such risks being known, appreciated, and accepted by me.

SIGNATURE OF PARTICIPANT

DATE

SIGNATURE OF PARENT/LEGAL GUARDIAN (IF UNDER 18)

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