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The Advertiser-Tribune's
Color Me for a Cure 5K fun run/walk
Sunday, May 3, 2015 at Meadowbrook Park, Bascom
Registration: 12:30-1:45 p.m.
Birthday bash speakers: 2 p.m.
Race: 2:30 p.m.
Awards: when last participant finishes
Event Info: “Color Me for a Cure” is a 5K charity race benefiting Relays For Life of
Tiffin and Fostoria and American Cancer Society. Cancer survivors will toss colored
powder onto runners at various points throughout the course. Runners should plan to
dress accordingly. The race will not be timed. In case of severe weather, a decision to
postpone it until later in the day will be made by noon. In case of postponement,
information will be posted on the Relay For Life birthday bash Facebook page and The
A-T's website and Facebook and Twitter pages.
Location: The race will be at Meadowbrook Park, with registration occurring at the
Walnut shelter just inside the entrance. Runners, walkers and wheelchairs are welcome
(please, no rollerblades, skateboards, bikes, strollers, wagons or pets for everyone's
safety).
Registration: Cost is $15 per person by April 19 and $20 for those registering after
April 19. Registrations will be accepted the day of the race. Those registering after April
19 are not guaranteed a shirt. There will be no refunds under any circumstances.
T-shirt: Participants who pre-register and pay $15 will receive a white T-shirt with the
words “I race for” at the top. Permanent markers will be provided so participants can
write in why they race. Shirts will be available for pick-up at the registration table the
day of the race.
Awards: Awards will be presented to the top male and top female and top boy and top
girl. The Relay For Life team with the most participants also will be honored.
For more information, call Chris Monsour at (419) 618-1477 or Jill Gosche at (419) 9376134.
Please fill out all fields. Each participant must have his or her own
form. The entry fee of $15 is due April 19 to be guaranteed a shirt.
Everyone must pay $20 after April 20, including the day of the race.
Please make checks payable to Jill Gosche.
Age:____________ Gender: ____________
Shirt Size:
Adult: S M L XL XXL
Child: S M L
Name:______________________________________________________________
Address:____________________________________________________________
City:________________________________________________________________
State:_________________ Zip:______________ Phone:______________________
Email:_______________________________________________________________
Relay For Life team representing: __________________________________________
Waiver: I agree that by participating in this physical activity (the “event”) or use any event
facility/premises, I do so at my own risk. I assume all risk of injury, illness, damage or loss to
me or my property that might result, including without limitation, any loss or theft of personal
property. I consent to medical treatment in the event of injury, accident and/or illness during
the event. I agree on behalf of myself (and my personal representatives, heirs, executors,
administrators, agents and assigns) to release and discharge The Advertiser-Tribune,
Meadowbrook Park, Hopewell Township, Relay For Life, American Cancer Society, its directors,
employees and all other event sponsors, associates and volunteers from any and all claims or
causes of action (known or unknown) arising out of their negligence. I acknowledge that I have
carefully read this waiver and release and fully understand that it is a release of liability. By my
signature, I am waiving any right I may have to bring legal action to assert a claim against any
and all event sponsors and representatives for their negligence.
Signature of participant: ____________________________ Date:______________
(Parent/guardian must sign if participant is under 18 years of age.)
Attach payment and registration form and mail to:
Jill Gosche
Box 74
Bascom, OH 44809