Kim's 5K Run/Walk: "We're in this together!"
October 22, 2016
Register at BCMS 7:30 AM Run/ Walk Starts at MES at 8:00AM
505 Ward Ave, Morgantown, KY 42261
Name: __ _________________________
Address: _ _________________________
City:_ ____ __________________________
State/ Zip: _________________________
Phone: _________________________
E-Mail: _________________________
Emergency Contact Name:
___________________________________
Emergency Contact Phone:
___________________________________
PAYMENT The registration fee is $20 for early registration and $25 per runner/ walker on race day. Please complete one form per participant. Registration is non-refundable. All proceeds will benefit Kim Moore.
PAYMENT INFORMATION
Registration will not be processed without payment.
____ Check (Made out to Kim Moore)
____ Cash
T-SHIRT SIZE
YS YM YL S M L XL 2XL 3XL
Participant/ Volunteer Waiver for Registration know that running in/ volunteering for a road race is potentially hazardous activity, which could cause injury or death. I will not enter and participate unless I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this event, and am in good health, and I am properly trained. I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I attest that I have read the rules of the race and agree to abide by them. I assume all risks associated with running in this event, including but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I understand that bicycles, skateboards, baby joggers, roller skates or roller blades, animals, and personal music players are not allowed in the race and I will abide by all race rules. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Kim’s 5K Run & Walk, the city of Morgantown, all event 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 negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record of this event for any legitimate purpose.
Signature: ________________________________________
Date: _______________________
Parent’s Signature if under 18 years: _________________________________________________
Date: _______________________
For More Information Contact:
Ashlee House 270-526-0414
Melissa Renfrow 270-836-3861
Jennifer R. Scott [email protected] 270-799-6536
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