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Promoting Healthy Choices; Physically, Mentally and Spiritually
5k
– 8:00 a.m.
Saturday, May 16, 2015 •
A run that is Easy, Flat and Fast! Join in the FUN!
Runners and Walkers of All Abilities are Encouraged to Participate
To the Top High School Male and Female 5k Finishers
To the Top Middle School Male and Female 5k Finishers
AGE GROUP Prizes:
1st, 2nd and 3rd Place 5k Finishers in 5-Year Age Groups
And More...
• NEW for Kids •
• CBRC Chip Timing
100 Meter Dash
• Technical T-Shirts – Shirts & sizes guaranteed Ages 10 and under.
Medals will be awarded.
through two weeks prior to race
• Other Great Giveaways
Packet Pickup: Friday, May 15, 2015 from 3:00 - 5:30 p.m.
At the Young Life Office – 2420 41st Street, Moline, IL
Chip Pickup:
$23 (5k) • $10 (100m) THROUGH March 30th
$25 (5k) • $15 (100m) AFTER March 30th
(through May 15th)
$30 (5k) • $20 (100m) ON Raceday
OR Mail Form and Check to:
Young Life Quad Cities
PO Box 582, Bettendorf, IA 52722
Our Premier Sponsor
To the Overall Male and Female 5k Finishers
$100 YOUNG LIFE CAMP CA$H Prizes:
GetMeRegistered.com/
YouWereMadeForThis5k.com
Saturday, May 16, 2015 from 7:00 - 7:45 a.m.
Ben Butterworth Parkway at Old River Road, Moline, IL
Race Start:Ben Butterworth Parkway at Old River Road (2.5 miles East of 1-74)
• 5k Runners — Line up at 7:50 a.m.
• 100 Meter Dash Runners — Line up at 8:50 a.m.
New This Year – Pancakes Post Race Party! Watch for more.
Support Young Life – Register Today!
5k
$200 CA$H Prizes:
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You Were Made for This
You Were Made for This
TE R
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online at:
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Reset Form
First Name: ________________________________
Last Name: ________________________________
Address: __________________________________
City: _________________ State: ____ Zip: _______
Email: ____________________________________
Date of Birth: _____/_____/_______ Age: _______
Phone #: ______________ Addl Donation: $________
Gender: q Male q Female
Adult Shirt Size: q S q M q L q XL q XXL
Youth Shirt Size: q 2T q 3T q YS q YM q YL
WAIVER: I know that participation in a road race is potentially hazardous. I should not
enter and run or walk unless I am able and properly trained. I know that, although police
protection is provided, there may be trail traffic on the course route. I assume the risk of
running or walking along the trail. I also assume any and all other risks associated with
participation in this event, including but not limited to falls, contact with other participants,
the effects of weather including high heat and/or humidity and cold temperatures, and
conditions of the trail, all such risks being known and appreciated by me. I attest and
verify that I am physically fit and sufficiently trained for the completion of this event. I also
authorize first aid and/or treatment to be rendered in case of any emergency. I hereby
consent to and authorize the use and reproduction, in print or electronic format, by Young
Life Quad Cities or anyone authorized by Young Life, or any and all photographs which
have been taken on this day for any publicity purposes without compensation. I also
understand, in which case the Race Directors deem the weather conditions to be unsafe
for the start or continuation of the race, that the race may be postponed or canceled.
Should I choose to stay on the racecourse, I do so at my own risk. All entry fees are
non-refundable. Having read this waiver and knowing these facts and in consideration
of your accepting my entry, I, for myself and anyone entitled to act for my behalf, waive
and release Young Life, management personnel and all sponsors of the event, their
representatives and successors, from all claims or liabilities of any kind arising out of
my participation in this event even though that liability might arise out of negligence or
carelessness on the part of the persons named in this waiver.
Signature: _____________________________________
(Parent if Under 18)
Date: ________________________________________