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Colors For Kids 5K FUN RUN
REGISTRATION AND WAIVER FORM Date: Saturday April 18, 2015
Time: Registration at 7:00AM
Zumba Warm-Up at 8:00AM
Run Starts at 9:00AM
Entry Fees: Before Midnight March 22nd $20 per person.
After March 22nd $30 per person.
Location: Brandywine Junior- Senior High School Cross Country Track
1700 Bell Road Niles, MI 49120
Mail your registration by 4/21/14 to
Niles Service League
PO Box 704
Niles, MI 49120
Make Checks Payable To: Niles Service League
T-Shirts: Each pre-registered participant will receive a commemorative t-shirt. T-shirts are not guaranteed for
late or race-day registrants.
Proceeds: All proceeds will go directly to The Niles Service League, which benefits the children of the
Brandywine, Buchanan and Niles area.
*Waiver: I, for myself or as parent or guardian, hereby assume all the risks and hazards incidental to the conduct of the
activities. I understand that no insurance coverage is provided by the race coordinators and sponsors. I assume all
risks associated with running in this race including but not limited to, falls, contact with other participants, the effects of
the weather and conditions of the course. I further give permission for proper emergency care to be rendered to myself
or child should I not be available or able to give such permission. All fees are nonrefundable. Race will take place rain or
shine. In the event of extreme weather conditions or some other unforeseen act of God that may prohibit the race, all
fees are nonrefundable. Having read this release and knowing these facts and in consideration of your accepting my
entry, I, for myself and anyone entitled to act in my behalf waive and release Niles Service League, and their
representatives and all other sponsors of the race, or any other persons assisting with the race, from all claims and
liabilites of any kind arising out of my participation in the race even though the liability may arise out of negligence or
carelessness on the part of the persons referred to in this waiver. I also give permission for the free use of my picture in
broadcasts, newspaper, posters, advertising, social media, etc. for any future event given by the Niles Service League.
Participant Name ______________________________________
Address ______________________________________________ City __________________ St ______ Zip ________
Phone: _________________________________
Age ________
Male _______
Email: ______________________________________
Female ________
Adult T-Shirt Size (circle one): Small Medium Large XLarge XXLarge
*I HAVE READ THE WAIVER (MUST INITIAL)
AGREE _____________
**Consenting Adult for minor participants under 18 years of age __________________________________________________
Niles Service League
PO Box 704 Niles MI 49120
Contact Ph# 269-- 591-- 1246
http://nilesserviceleague.yolasite.com