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4th Annual Chatfield College 5K RUN/WALK
& Mini Health Fair
Saturday, July 18th, 2015
20918 State Route 251, St. Martin, OH 45118
Registration/Check-in: 8:00 am | 5K Run starts: 9:00 am | 5K Walk starts: 9:01 am
Please fill out a separate form for each participant.
_____________________________________________________________________________
First Name (Please Print)
Last Name
□ Male
□ Female
_____________________________________________________________________________________________
Address
_____________________________________________________________________________________________
City/State/Zip
Phone #
Email
I will be participating in the: □ 5K Run
□ 5K Walk
T-shirt Size (check one):
□ Under 13 □14-19 □20-29 □30-39 □40-49 □50-59 □60-69 □Over 70
□ Under 30 □30-49 □50-69 □Over 70
□ S □M □L □XL □2XL
Registration Fees
Registration fee includes race entry, T-shirt, and
post-race refreshments.
Note: Those registering onsite June 20th are not
guaranteed a shirt or correct size.
Adults (over 18)
$15
Students and Children $8
Optional additional donation gladly accepted.
$______________ Amount Enclosed
Pre-Registration
To be pre-registered your completed registration form
must be postmarked by Saturday, June 13, 2015.
Make checks payable to:
Chatfield College
Mail registration form/checks to:
Chatfield College 5K
Attn: Brianna Houchens
20918 State Route 251
St. Martin, OH 45118
Awards
Directly following the race, a trophy will be awarded to the overall winner. Medals will be awarded to top
finishers within each division.
Waiver and Release Statement (All participants must read and sign)
I understand that participating in this event will subject me to potentially dangerous conditions, including uneven terrain,
potentially warm temperatures, and other runners/walkers who may cause falls or other injuries. I certify that I am in proper
physical condition to participate in this event and hereby release and hold harmless Chatfield College and its volunteers from any
and all demands, claims, damages, or suits arising from or relating to bodily injury or personal property loss or damage sustained
by me, or property damage or bodily injury to others caused by me during or because of participation in this event. I agree to
follow all rules set forth for this event. I further grant full permission to Chatfield College to use any photographs of the event for
any reasonable purpose.
___________________________________________________________________________________________
Signature of Participant (or signature of Parent/Guardian if participant is age 17 or under)
Date
___________________________________________________________________________________________
Printed Name of Participant or Parent/Guardian