The PINWHEEL PROMISE - Franklin Community Schools

The PINWHEEL PROMISE
Child abuse awareness
5k Family Walk and fun day
“April is a time to celebrate the important role that communities play in protecting children”
April 25th, 2015
Registration begins at 8:00 AM
Kick-off for Awareness 9:00 AM
Walk to follow
Children’s activities from 9-noon
Vendors on-site from 9-noon
LOCATION:
Franklin Parks and Recreation Center
396 Branigin Blvd.
Franklin, IN 46131
Registration held at large shelter house, located just down the hill from the pool.
Walk will begin and finish at pool parking lot.
REGISTRATION:
To qualify for Early Registration, please mail/bring completed Registration form and entry
fee to: 520 Tracy Road Whiteland, IN 46184 Attn: Rachelle Steele.
Checks may be made payable to The Children’s Bureau.
Registrations will also be accepted the day of the event beginning at 8AM.
COST:
Advance registration:
Race-Day registration:
$15.00 per adult, includes T-Shirt
$10.00 per child, includes T-Shirt
$40.00 per family, includes up to 4 T-Shirts
(Additional shirts may be purchased for $8.00 each)
Pricing remains the same. However, T-Shirt supply will be limited for
registrations received after April 14th.
Amenities:
Free refreshments and snacks will be available to participants!
Coupons, prizes, and give-aways!!
Fun and engaging activities for children!!!
Informational booths, vendors and activities for families and the community!!!!
CONTACT:
Coordinators: Rachelle Steele, 535-3326 and Teddi Adams, 340-9568
Email: rsteele@childrensbureau.org and Teddi.Adams@dcs.in.gov
REGISTRATION FORM
The pinwheel promise
Child abuse awareness
5k family walk
Please complete one form per participant/family. Forms, along with entry fee, should be mailed or
brought to: 520 Tracy Road Whiteland, IN 46184 Attn: Rachelle Steele.
Checks may be made payable to The Children’s Bureau.
Please print
NAME:
NAME:
NAME:
NAME:
NAME:
Address:
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First
Last
Age
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First
Last
Age
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First
Last
Age
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First
Last
Age
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First
Last
Age
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Street
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City
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State
Zip Code
Contact Phone Number:
_____________________________
Contact Email:
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T-Shirt Size(s):
Youth Size(s): ______________
Adult Size(s): ______________
(
)
In lieu of T-Shirt(s), I/we elect to donate full registration fee to Prevent Child Abuse.
COST:
Advance registration:
Race-Day registration:
$15.00 per adult, includes T-Shirt
$10.00 per child, includes T-Shirt
$40.00 per family, includes up to 4 T-Shirts
(Additional shirts may be purchased for $8.00 each)
Pricing remains the same. However, T-Shirt supply will be limited.
Waiver and Release:
I know that my participation in an organized running or walking event, regardless of distance, includes an element
of risk. I understand that I should not enter and participate in “Child Abuse Awareness 5K” (hereinafter “this
event”) on April 25th, 2015 unless I am medically able and properly trained. I agree to abide by any decision of an
event official, relative to my ability to compete this event safely, and I further agree that event officials may
authorize necessary emergency treatment for me. I also understand that both vehicle traffic and spectators may be
present along the course, and I assume the risk of participating under such conditions. I further assume any and all
other risks associated with my participation in the event, including but not limited to, illness, traveling to and from
the event, falls, contact with spectators or other participants, the effects of the weather (including temperature
extremes and humidity), and the surface condition of the 5K route, roads, bike trail, and sidewalks, all such risks
being under-stood and appreciated by me.
By signing this waiver, I am agreeing to WAIVE and RELEASE any and all rights and claims for negligence,
injury, damages or losses that I may incur against all participating agencies involved in the planning, coordinating,
sponsoring or holding this event.
Having read this waiver and knowing these facts, and in consideration of the acceptance of my entry, I hereby for
myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, covenant not to sue and I
waive, release, and discharge all subsidiaries, affiliates, assigns, representatives, and successors of the forgoing: City
of Franklin, Franklin Parks & Recreation Department, contractors, employees, all participating agencies involved in
the planning, coordinating, sponsoring or holding this event and any other personnel in any way assisting or
connected with this event from any and all claims or liability of any kind or nature whatsoever arising out of my
participation in this event, even thought that liability may arise of negligence or carelessness on the part of the
parties named in this waiver.
I also understand and agree that any sponsor may subsequently use, for publicity or promotional purposes, my name
and/or pictures of me participating in this event without liability or obligation to me.
Entries cannot be accepted without a valid signature. Entries from minors will be accepted only
with a parent’s or legal guardian’s signature.
Signature of Participant
Date
___________________________________
___________________
Signature of Parent/ Legal guardian
Date
(for participants under 18)
___________________________________
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