BLOSSOM RUN
Saturday May 9th, 2015 at Dock Park, Egg Harbor
5 Mile Run, 2 Mile Run/Walk, 1 Mile Youth Run
Race Day Registration 7:00 am - 8:00 am
5 and 2 mile events begin at 8:30 am
1 mile Youth Fun Run begins at 9:30 am
Award Ceremony begins at 10:15 at (approximate)
$15.00 Adults (Early Registration ends April 25)
$20.00 Adults (April 26 through race day)
$10.00 Youth 12 and under (No late fee)
Door Prizes Awarded:
Apparel to each participant
Medals for 1st, 2nd, 3rd places by age group
Awards top finisher in each category
BIB #
Register in person at the YMCA, by
mail or on-line at
www.doorcountyymca.org.
Registration begins February 27
Make Checks Payable to Door County YMCA and return to Door County YMCA - Blossom Run
1900 Michigan Street, Sturgeon Bay, WI, 54235 Phone (920) 743-4949 Fax (920) 743-8812
Name:____________________________________________________________________________________ p Male p Female
Date of Birth: ________________________________________ Age on Race Day: _______________
Address: __________________________________________________________________________________________________________
City: _____________________________________________________________________ State:_______________ Zip:______________
Email Address:___________________________________________________________ Phone:________________________________
Race: p 5mile
p 2mile
p Youth 1 Mile
T-Shirt: p Youth S p Youth M p Adult S p Adult M
p Adult L
p Adult XL
Emergency Contact: ______________________________________________ Phone:____________________________________
Fee Enclosed: $10.00 (12 and under) $15.00 thru April 25 $20.00 April 26 and later
***Please sign waiver of liability on reverse side. A signed waiver is required of each race participant
Please sign waiver of liability below. A signed waiver is required of each race participant.
Waiver of Liability
Liability: I understand the physical activities in which I, my child, and/or my team participates(s) in with the Door County YMCA
include, but may not be limited to running/walking. I agree to assume all liability and release the Door County and the Village of
Egg Harbor and any other associated parties for any liability for the risk of injury, illness or death on account of my and/or my
team’s presence in the run/walk whether cause by negligence of the Door County YMCA or another person on the premise or at
the sponsored activity.
Photo/Talent Release: I hereby irrevocably release, consent and authorize the Door County YMCA and its agents to use my and/
or my teams photography/likeness/voice, as it pertains to my and/or my team’s participation with the YMCA, in any manner for
promotional efforts without expectation or right to any reimbursement in connection with it’s use.
Race canceled due to severe weather. No refunds
Participants/Parent Signature: __________________________________________________________________________________________
Date:_________________________________________