Jack Mead 5K for a cure

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					                   Jack Mead 5K for a cure
                            Sponsored by: Wauconda High School Varsity Club & Village of Island Lake
                          **This is a Charity event all proceeds will go to American Cancer Society**

                                       Saturday, October 15, 2011
Date:                 Saturday, October 15. 2011                                    Entry Fee:      $10.00 min donation until Sept. 30, 2011
                                                                                                    $20.00 min donation on Race Day (t-shirts
Time:                 8:30 a.m. Race Start                                                          available only while supplies last)
                      7:15-8:25 Check-In and Late Registration at                                   SORRY NO REFUNDS
                      Eastway Park
                                                                                    Registration:   Clip and mail your signed registration form
Distance:             5 kilometers (3.1 Miles)                                                      & check for $10 before September 30th, 2011
                                                                                                    payable to, “Wauconda High School” with a
Course:               A scenic loop course around Island Lake                                       note Jack Mead, Donations will be accepted.
                      from Eastway Park and back with an
                      abundance of rolling hills.                                                   Jack Mead 5K for a cure
                                                                                                    Village of Island Lake
Parking:              Located at the Village Hall off Greenleaf,                                    3720 Greenleaf Avenue
                      1 block east of Eastway Park.                                                 Island Lake, IL 60042

Questions:            Email –                                         Entries must be submitted/postmarked no later than
                                                                                          Sept.30, 2011.

        JACK MEAD 5K For A Cure Walk/Run                                                 REGISTRATION FORM & WAIVER
                                           Map & Forms available online at:

        Last Name                                                                 First Name

        Home Phone                                                                Business Phone

        Address                                                                   EMAIL ADDRESS:

        City                                                              State                     Zip

        T-Shirt Size – ADULT:          S M L XL                 SEX: M F           AGE: ___________          DATE:______________
                                                                                       (if under 18)
        WAIVER OF LIABILITY: In participating in the Jack
        Mead 5K Run(“Run”), I recognize and acknowledge that there
        are certain risks of physical injury and I agree to assume the full
        risk of any injuries, including death, damage, or loss regardless
        of severity which I may sustain as a result of participating in the
        Run. On behalf of myself and my spouse, children, heirs and
        beneficiaries, I hereby fully release, discharge, waive and
        relinquish all claims, including but not limited to, any and all
        claims for injuries, including death, damage or loss which I
        may have or which may accrue to me, or any of the
        aforementioned people, as a result of my participation in the
        Run against the Village of Island Lake, the Wauconda High
        School Varsity Club and their respective officers, agents,
        servants, elected or appointed officials, and employees and I
        hereby covenant not to sue the Village, Varsity Club or any of
        the aforementioned people for any reason.

        RUNNER’S SIGNATURE________________________


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