Saturday, April 25, 2015
Cost Walk/Run (non-refundable): $20.00 before April 11th — $25.00 after April 11th, 2015
-Kids (12 & under): $10.00 *kid’s must be supervised at race
-Make checks/money orders payable to Sanilac ISD with 5K noted in the memo.
-Funds raised will be used for playground equipment at Maple Valley ISD and to support
students with Autism Spectrum Disorder throughout Sanilac County.
-Registration form also available on Facebook.
Day of Race
Registration 5K: 8:00 – 8:45 a.m
Location: Maple Valley, 138 Maple Valley St., Sandusky, MI
Start of 5K race: 9:30 a.m.
Start of kid’s 1Mile: 9:00 a.m.
Route: Start at Diamond Trail parking Lot, Left on Maple Valley Rd, Right onto W. Speaker St, Right
onto Lexington St, Right onto Redmond St, Left onto S. Custer St, Right onto Jean St, Right onto
Maple Valley Rd, Enter Diamond Trail park and Finish on Diamond Trail.
Questions: please call (810) 648-2200 ext. 4110 and ask for Kim Foster or message us on Facebook.
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Detach & complete this form. Send with entry fee to: Kim Foster, Attn: Autism 5K, 46 N Jackson Street, Sandusky, MI
48471
Name:___________________________________________________________ Male / Female (circle one)
Age:_____ City:_________________ State:____ Phone:________________ Run / Walk (circle one)
In case of an Emergency call: Name:___________________________________ Phone:__________________
Walk/Run entry fee: $20.00 before April 11th or $25.00 after April 11th, 2015. Kids (12 and under): $10.00.
Please note: The entry fee prior to April 11th includes a t-shirt. Please register by April 11th, 2015 to ensure that you
receive a t-shirt. Thank you.
Please circle size: Small Medium Large X-Lrg XX-Lrg XXX-Lrg / Youth sizes: Small Medium Large X-Lrg
Waiver: Running a road race involves risks of serious injury. Potholes and other surface debris exist on the course. Motorists,
cyclists, pedestrians and animals may accidentally or deliberately create hazards. Also the physical strain of a long distance race
can lead to serious health problems. I have read and understand this statement and agree to assume all risks of personal injury
or other physical or emotional ailment. I hereby waive all liability, claims against the City of Sandusky, Sanilac County, Sanilac
Intermediate School District, Sandusky Chamber of Commerce and any and all sponsors.
Signature:___________________________________________________
Date: _____________________________
Signature (parent or guardian if under 18 years of age):__________________________________________________