Registration Form RDD 2012a by 1yhM8JK


									   Kinship Program                                     

  All proceeds benefit Kinship Partners of
  Staples/Motley. Kinship is a mentoring
program for at-risk youth. These youth are        Course Description
paired with a caring adult mentor who is a
    positive role model. Kinship provides     This 5k road race starts at Staples Alliance
                                                                                                August 25, 2012
     monthly activities and ways for the
matched youth to interact and get to know
                                              Church and goes north on 8th Street until
                                              Prairie Avenue where runners will head west         Race begins at
   their mentor. The Railroad Days Dash
  believes in the mission of Kinship and is
                                              down a slight decline and back up a slight
                                              hill. Runners will then go south on flat 4th           8:30 am
                                              Street until the Warner Road where they will
 proud to be donating all proceeds to this
                 worthy cause.                angle east 1 block to 5th Street and resume      Registration closes at
                                              running south. Runners will continue
 Kinship Partners of Staples/Motley can be    running south on a long straight stretch on
                                              5th Street until 3rd Avenue NE, where they
                                                                                                     8:00 am
                reached at:
                                              will turn east and run up and back down the
       Kinship Partners, Inc.                 only significant hill on the course. Runners
             PO Box 281                       will continue on 3rd Avenue NE until 8th
                                              Street, where they will turn north and start             Where:
        Staples, MN 56479
         (218) 296-6565
                                              the home stretch. This is where the racing
                                              will heat up as this last long stretch is a         Start and finish at
                                              straight and almost flat burst back to Staples
                                              Alliance Church. The course is set up to be      Staples Alliance Church
                                              fast and runner-friendly. Come and set your
                                              5k personal record!                                located at 1512 8th
        2011 Sponsors                                                                           Street NE in Staples,
    Staples/Motley Dairy Queens
      Lakewood Health System
                                                     For more information about the
           Staples Curves                     Railroad Days Dash contact the race director
   Staples Community Foundation                 Nick Schultz at or
   Arvig Communication Systems
                                                            (218) 894-1201.
                                                                                                All proceeds benefit
                                                                                                Kinship Partners of
        Race Information                                     2012 Dash highlights!                               Official Entry Form
Location:                                                  ***Back for the third year is the Team           Name______________________
                                                           Competition! In order to compete in the
Start and finish at Staples Alliance Church Parking lot.
                                                           team competition, your team needs to             Age_______(on race day) Sex M                       F
Staples Alliance Church is located at 1512 8th Street
                                                           consist of at least 4 runners (the top 4
NE in Staples, MN.
                                                           times will be used for the competition).         Phone______________________
Divisions:                                                 When you send in your registration, please       Address____________________
                                                           remember to specify that you are
Mens and Womens:                                           competing as part of a team and give your        City________________________
Overall winner, under 20, 20-29, 30-39, 40-49, 50-         team name. When competing as a team
59, 60-69, 70+.                                            member, you are also eligible for individual     State_________ Zip_________
                                                           awards! The cost for each registrant for
Awards are guaranteed for the top 2 finishers in each
                                                           each team is $25. Grab 3 friends and run
                                                           as a team! (The Motley DQ team is going          T-Shirt Size: Men’s                    Women’s
The fastest team will win a team award.                    for a three-peat this year!)
                                                           ***The course it USATF certified.
                                                                                                                       S      M       L      XL       XXL
                                                           ***“Beat the race director” is back!                Are you part of the Team
Winners will be listed in the Staples World. Results
for all participants will be posted ASAP following the
                                                           Nick Schultz will run the course within 2         Competition? Yes No (circle one)
                                                           days before the Dash and will have
                                                           witnesses verify his time. The time to beat                  If so, what team?
Registration:                                              will be posted and available for all Dashers        _________________________________________
                                                           to see on race day. If you beat Nick’s time,
Before or on August 17 Cost:           $20.00              you will receive a voucher for a free large                         Waiver
                                                           Blizzard at the Staples or Motley Dairy
After August 17 Cost:        $25.00                        Queens. Any woman who beats Staci
                                                                                                               (must be signed by parent or guardian if under 18)

                                                           Schultz’s time will also receive a voucher!      I, the undersigned, agree to indemnify and
Team-Member Cost:           $25.00                                                                          hold harmless beneficiaries, sponsors,
Mail to: Race Director
                                                           ***Starting around 9:30 we will have the         volunteers and anyone else associated with
                                                           third running of the FREE Jr. Dash! The Jr.      this event from all cost, expense and liability
            25259 County Road 2                            Dash is for kids under 12 years old and is       arising directly or indirectly from my or my
            Staples, MN 56479                              about 1K (.62 miles) in length. It will finish   child’s participation in this event. I agree to
                                                           at Staples Alliance Church and will be a fun     assume liability for any loss, damage or other
Or Drop off At: Staples or Motley Dairy                    “family” event. Let’s all cheer these Jr.        liability resulting from my or my child’s
Queens.                                                    runners on to the finish! Kids can register      participation in this event.
Make checks payable to Kinship Dash.                       for the Jr. Dash between 8:00 and 9:15 on
                                                           race day. Each participant will receive a
All preregistered runners will receive a logo t-shirt.
                                                           chance at unlimited ride wristbands for
Preregistered runners are those whose registration                                                          Participant Signature
                                                           Nickelodeon Universe in the Mall of
form is received by Friday, August 17, 2012.
Runners registering after August 17, 2012 will get t-
shirts on a first-come first-served basis.
                                                                                                            Parent/Guardian Signature

To top