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Kim's 5K Run/Walk: "We're in this together!"

Date: 
Saturday, October 22, 2016 - 7:30am

 

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