6TH ANNUAL
MOUNTIES ON THE MOVE 5K
RUN/WALK & KIDS’ FUN RUN
Date: Saturday, May 16th
Northwest Coordinated School Health’s 6th Annual 5K & Kids’ Fun Run
Non-Competitive Run/Walk
This year the race will support Pat Spitler Memorial Scholarship Fund &
Coordinated School Health
Schedule
Community Fitness Event
Free Healthy Snacks & Face Painting
Registration 8:15-8:45am High School Track
Kids Fun Run 9:00am
5K Run/Walk 9:15
Free Picture with the Mountie
Yes, I would like to run/walk:
$6.00 Adult Run/Walk (by 5/4)
$8.00 Adult Run/Walk (5/5 or later)
$3.00 Child Run/Walk/Kids Fun Run
(by 5/4)
$5.00 Child Run/Walk/Kids Fun
Run (5/5 or later)
Total enclosed: ___________________
T-Shirts Additional $10 each,
guaranteed if ordered by 5/4:
Make Checks Payable To:
Northwest Community Schools
Adult Shirt ___S ___ M___ L ___XL
____XXL ($1 Extra)
Child Shirt ___YS ___ YM ___YL
I would like to make a contribution to:
Pat Spitler Memorial Scholarship Fund
$5
W = Walk
$10
R = Run
$_________
Mail:
NWHS Attn: Nicole Tokar
4200 Van Horn Road
Jackson, MI 49201
Drop off:
Any Northwest Building
Kids = Kids Fun Run
Participant Name: _________________________ W R Kids Participant Name:________________________ W R Kids
Participant Name:_________________________ W R Kids Participant Name:________________________ W R Kids
Phone:_________________________ Email:_____________________________________________________________
General Release: I know that strenuous exercise is a potentially hazardous activity and that I should not enter this event unless I am medically able and properly trained. I agree to abide by
any decision of a race official relative to my ability to safely complete the race. I assume all risks associated with participating in this event including, but not limited to, falls, contact with
other participants, the effects of the weather, traffic, and the conditions of the road/trails, all such risks being known and appreciated by me. Having read this waiver and knowing these
facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the race organizers, Coordinated School Health Committee and
Northwest Community Schools and all of it's employees, representatives, or agents, and all sponsors, their representatives and successors, from all claims and liabilities of any kind arising from
my participation in this event, even though that liability my arise out of negligence or carelessness on the part of the person(s) named in this waiver. I understand that bicycles, skateboards,
roller skates, in-line skates, and animals are not allowed in the race and I will abide by these restrictions.
Signature_______________________________________________________________ Date_______________________
(Parent/Guardian must sign for entrants under 18)