Registration Form 5K RunWalkKids Run

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Registration Form 5K RunWalkKids Run Powered By Docstoc
					                                                                                   Registration Form 5K Run/Walk/Kid’s Run
                                                                   Complete this form in its entirety and return to TKA by August 24th or register
                                                                   online at ($3.25 processing fee applies to online registration).
                                                                                               Complete one form per registrant.

                                                                 First Name: ____________________________________________________
                                                                 Last Name: ____________________________________________________
Date and Race Time: Saturday, August 29, 2009 @ 7:30 a.m.
                                                                 Gender: Male / Female            Birth Date: ______________ Age on Race Day: ______
Location: The King's Academy, 8401 Belvedere Road,
West Palm Beach, FL 33411                                        High School (if applicable) ________________________________________

5K Fees: Adults $25, Students (18 & under) $20,                  Email: ________________________________________________________
Race Day Registration $30                                        Phone: _______________________________________________________
Kid's Run (Free, does not include t-shirt): Kid's 10 and under
                                                                 Address: ______________________________________________________
will run one lap around the track (1/4 mile). Begins at
approximately 7:15 AM. Youth t-shirts available for $10 and      City: ___________________________ State: ____ Zip: ________________
must be pre-ordered.
T-Shirts: Each pre-registered 5K race participant will receive      Register each 5K and Kid’s Run participant individually. Additional forms are
a custom design commemorative t-shirt. T-shirts are not          available for print from Make checks payable to The King’s Academy.
guaranteed for late or race-day registrants.
                                                                 5K Race Adult $25 ____                   OR        5K Race Student (under 18) $20 ____
Course: Multi-surface, off-road, USATF certified by Gene
                                                                 Are you running or walking? Running / Walking                    5K T-Shirt Size? S M L XL
Witkowski that begins and ends on The King's Academy
beautiful 60 acre campus.                                        Kid’s Run (10 & under) (no charge) _____ Kid’s Run t-shirt $10 YS                           YM        YL
Timing: Electronic    timing   and    scoring   provided   by
AccuChipUSA.                                                                                                    WAIVER
Awards: Awards will be presented to the top male and             I know that running is a potentially hazardous activity. I should not enter or run this event unless I am
                                                                 medically able and properly trained. I agree to abide by any decision of a race official relative to my
female overall, top male and female masters, and top male        ability to safely complete the run. I assume all risks associated with running in this race including, but
and female in the following age divisions: 11-14, 15-19,         not limited to, falls, contact with other participants, the effects of weather, including high heat
20-29, 30-39, 40-49, 50-59, 60-69, 70 and over.                  and/or humidity, the conditions of the road and traffic on the course, all such risks being known and
Sponsorship: Any business interested in participating should     appreciated by me. All fees are nonrefundable. Race will take place rain or shine. In the event of
                                                                 extreme weather conditions or some other unforeseen act of God that may prohibit the race, all fees
download the sponsorship information from
                                                                 are nonrefundable. Having read this waiver and knowing these facts, and in consideration of your
Proceeds: Proceeds from this event benefit The King's            acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and
Academy Annual Fund.                                             release the event, and all sponsors, their representatives and successors from all claims or liabilities
                                                                 of any kind arising out of my participation in this event even though that liability may arise out of
Race Restrictions: Strollers/baby joggers, dogs, rollerblades,   negligence or carelessness on the part of the persons named in this waiver. Registration will not be
skates, skateboards, bikes, scooters, or headphones are not      accepted without acknowledgment of waiver signature:
permitted on the race course.

                                                                 Signature: _____________________________________________ Date: ___________________

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