8th Annual Deer Dash 5K & 1-Mile Fun Run Saturday, May 16, 2015 Deer Crossing Elementary School 10601 Finn Drive New Market, MD 2177410 Benefits the Deer Crossing Elementary School PTA. Packet Pick-Up and On-Site Registration: Friday, May 15 3:30—7:00 pm Saturday, May 16 7:30—8:15 am Race Day Schedule: 5K Run/Walk 1-Mile Fun Run Awards **Register by April 30th to be Guaranteed a T-Shirt!** 8:30 am 9:30 am 10:00 am — — — — — — — — — — — — — One form per family please — — — — — — — — — — — — — ENTRY FEES By 4/30 After 4/30 Adult (12 and up) $25 $30 DCES Staff $10 $10 Student $15 $15 Family* $55 $60 Family Sponsor** $100 $100 * Includes related children and up to 2 adults ** Family registration with name on race T-shirt if received by 4/30 Participant Name (s) *Shirt Sizing Chart: Youth : XS (4), S (6/8), M(10/12), L (14/16), XL (18/20) Men's: XS, S, M, L, XL, 2XL, 3XL, 4XL How to Register: 1. Online at imathlete.com/events/deerdash5k no later than May 13, 2015. 2. Fill out and return this form to DCES. (make checks payable to DCES PTA.) 3. At Packet Pick-Up on Friday, May 15th or Saturday, May 16th. Age Grade Level/ Stroller Gender (M/F) 5K, Fun Run or Both Fee Women's: XS (2), S (4/6), M (8/10), L (12/14), XL (16/18), XXL (20/22), 3XL (24/26), 4XL (28/30) Address Phone Shirt Size (see chart below) TOTAL: TOTAL: Email Address Family Sponsors: Please enter the name exactly as you would like it to appear on the T-Shirt: __________________________________________________________________________________________________ *Stroller Runners* The child in the stroller will receive a T-Shirt, but will not receive a bib. Are you planning to participate in the Spring Challenge? ____ Yes ____ No If Yes, how many in group will participate? _______ Release: I the undersigned participant, intending to be legally bound, do hereby for myself and heirs, executors, administrators and assigns, forever waive, release and discharge any and all rights, claims and actions for damages that I may have, or that may hereafter accrue to me against the Maryland PTA including all units and councils, and all of their officers, directors, members and volunteers. I attest and verify that I am physically fit and able to participate in this event and acknowledge that I am aware of the inherent risks in participating in an athletic event of this type. Further, I grant permission for the use of any photograph or recording of this event for legitimate purposes. ____________________________________________ Participant Printed Name ________________________________________________ Signature _________________ Date If participant is under the age of 18: I am the legal guardian of Participant and hereby consent to his/her participation. I have read the foregoing release and agree on behalf of myself and the Participant to its terms. ____________________________________________ Parent/Guardian’s Printed Name ________________________________________________ Signature _________________ Date