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CHILDREN’S SQUARE U.S.A.’S
PLEASE READ THIS
WAIVER/RELEASE BEFORE
SIGNING REGISTRATION
5123 Leavenworth
Omaha, NE 68106
Phone: (402) 556-6765
Fax: (402) 556-7862
www.childrenssquare.org
1. I know that participating in a race is a potentially
hazardous activity, with both known and unknown
risks. I should not participate in the 2015 “Run for
the Young” unless I am medically capable for the
walk/run. I assume all risks associated with
participating in this event including, but not limited
to: falls, contact with other participants, the effects
of the weather, and the condition of the road. I
understand and appreciate such risks. Having read
this waiver and knowing these risks, and in
consideration of your accepting my entry, I, for
myself and anyone entitled on my behalf, waive and
release Children’s Square U.S.A. and all race
sponsors, their representatives and successors from
all claims or liabilities of any kind arising out of my
participation in this event.
5K RUN/WALK
FRIDAY, JUNE 5, 2015, 7 P.M.
AT
PEAK PERFORMANCE
519 N 78TH ST
OMAHA, NE
KEYSTONE TRAIL
2. I grant Children’s Square U.S.A. permission to
reproduce, publish, circulate, copyright, or
otherwise use any and all photographs and/or
videotape of me and/or my family, taken at the 2015
“Run for the Young.” Special permission will be
requested for photos, stories, videos, etc. that would
include the sharing of personal or confidential
information.
SPECIAL THANKS TO OUR
EVENT SPONSORS*
__________________________________________
Signature of Participant
__________________________________________
Name (Please Print)
__________________________________________
Date
McMahon
The
__________________________________________
Signature of Guardian (for children under 19 years of age)
Family
* of March 23, 2015
Race Day
Friday, June 5, 2015
7 p.m.
Race Location
Peak Performance
519 N. 78th St.
Omaha, NE
REGISTRATION FORM
DATE _______________
NAME ___________________________________
ADDRESS ________________________________
__________________________________________
PHONE ___________________________________
EMAIL ___________________________________
GENDER _____ male _____ female
RACE DESCRIPTION:
5K Flat and Fast throughout the trail. Walkers
are welcome to start behind the runners.
The race will start at The Keystone Trail
outside of Peak Performance.
RUN DIVISIONS:
“Run for the Young” is an excellent way to show
support and appreciation for our foster families.
Proceeds fund summer camps for children in our
foster care homes.
“RUN FOR THE YOUNG”
Providing family foster care and support
services in the Omaha, Nebraska community
since 1991, Children’s Square U.S.A.’s foster
care program provides positive family
environments for Nebraska children needing
out of home care. Our families enriched the
lives of nearly 120 children in 2015. Fortytwo children are currently in care with 38 foster families.
You, too, can make a difference by
becoming a foster parent, joining us for the
“Run For The Young” or making a gift today
to help fund summer camps.
• Age 19 and under
• Ages 20 to 29
• Ages 30-39
• Ages 40 to 49
• Ages 50-59
• Ages 60-69
• Ages 70 and over
For more information about Run for the
Young or foster parenting opportunities,
please contact Mary Uhlig at (402) 556-6765.
DATE OF BIRTH __________________________
CIRCLE SIZE OF T-SHIRT BELOW:
S
ADULT SIZES:
M L XL XXL
YOUTH SIZES:
M L
PRE-REGISTRATION
Pre-registration application and payment must be
received or postmarked by Wednesday, June 3,
2015. Those who pre-register will receive a “Run
for the Young” t-shirt.
Method of Payment:
… Check* … Cash … Online
*make checks payable to Children’s Square U.S.A.
Please mail or hand deliver
your registration and $15 fee to:
Children’s Square U.S.A.
5123 Leavenworth St
Omaha, NE 68106
Visit www.childrenssquare.org
to register online.
Registration on Race Day
You may register the day of the race for an
additional $5. The $20 entry fee may be paid by
cash or by check made payable to Children’s
Square U.S.A.
Registration will begin at 5:30 p.m. Remaining
t-shirts will be distributed while quantities last.