here - Girls on the Run

Kent County Girls on the Run 5K Celebration
Adult Registration Form
Come support Girls on the Run by participating in the Celebratory 5K event.
May 16, 2015 at Calder Plaza at 9:45am. This race is not timed.
Name _________________________________________________________________
Address________________________________________________________________
DOB (dd/mm/yyyy) ______________
Age on Race Day: ________
Sex: M / F
Email Address___________________________________________________________
Shirt Size Selection:
No Shirt
Small
Medium
Large
XL
Must be 16 or
older on Race Day
to Participate
2XL
Emergency Contact
Name __________________________________________
Registration
P5K Adult Registration by May 11 ($28)
Register by April 12 to
guarantee event t-shirt
Additional Donation Total: _______________
Phone: _______________
After May 11, registration is only available
online or at packet pickup ($30)
Would you like a receipt? (Please Circle One):
Yes
No
How will you participate in the Celebration 5K? (please select one):
PAdult runner, participating without a girl
PI plan to participate with my daughter
PPlan to participate with a girl and have been designated by the girl’s parent or guardian
PCommunity volunteer and would like to be assigned as a Running Buddy to a team or girl
Must contact Nika at program.kcgotr@gmail.com for background check
If you are running with your daughter or have been designated to run with a specific girl by her parent
or guardian please indicate below.
Name __________________________________________ School_________________________________
Waiver: In consideration of my participation in the 2015 Kent County Girls on the Run Celebratory 5K Run (‘The Event’), and with the understanding that my
participation in the Event is only on the condition that I enter into this agreement for myself, I hereby assume the risk and accept full responsibility for any
and all injuries (including death) and accidents which may occur as a result of my participation in this Event and release from liability Kent County Girls on
the Run,Calder Plaza and any additional sponsors and each of their officers, directors, volunteers and employees. I hereby waive any claim I may hereafter
have as a result of any and all injury to my participation in the Event. I hereby agree to indetinify all of the above-named parties for any and all claims,
including attorney fees and costs, which may be brought against any of them by anyone claiming to have been injured as a result of any injury to me or my
property which may occur as a result of the Event. I certify that I have read and am fully legally competent to make this agreement.
Pay By:
PCheck
PCash
(Checks can be made payable to KCGOTR)
Mail this form to: KCGOTR - 5K
4835 Eastern Ave SE,
Kentwood MI, 49508
Forms must be received by May 11
Signature ___________________________________________________ Date______________________