Registration Please make checks payable to The Montessori Academy Return Registration and Payment to The Montessori Academy 530 E Day Rd, Mishawaka IN 46545 (p)574-256-5313 (f)574-256-5493 www.AnEducationForLife.com First Name: _________________________________________________________ Last Name: _________________________________________________________ Email: _____________________________________________________________ Address: ___________________________________________________________ City: _______________________________________________________________ State: _______ Zip: ___________________ Phone: _________________________ DOB: ___/_____/_____ Age on Race Day: _________ Gender: M F Event: 10K ($30 through July 31 / $33 Aug 1-Oct 17 / $38 Race Day Registration) 5K ($25 through July 31 / $28 Aug 1-Oct 17 / $33 Race Day Registration) 2K ($25 through July 31 / $28 Aug 1-Oct 17 / $33 Race Day Registration) Children’s Obstacle Course ($15 through Oct 17 / $20 Race Day Registration) T Shirts are only guaranteed to those who register by Oct 1. Please select your size preference. ○Adult S ○Ault M ○Adult L ○Adult XL ○Youth S ○Youth M ○Youth L Or... Register online by scanning this handy QR code with your smart phone! —————————Waiver of Liability————————— *Signature Required (parent/guardian if under 18)* I know that running in the Fall Frolic 10K,5K, 2K Fun Run and Kids Obstacle Course is potentially hazardous activity. I should not enter and run 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 run. 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, including extreme cold or high heat and/or humidity, traffic, and the conditions of the road. All such risks are known and appreciated by me. Having read this waiver and knowing the facts in consideration of your accepting my application. I, for myself and anyone entitled to act on my behalf waive and release The Montessori Academy at Edison Lakes, Center for the Homeless, its sponsors, its volunteers, race directors, and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all the forgoing to use any photographs, motions picture, recordings, or any other record of this event for any legitimate purpose. All persons under 18 years of age must have written consent of parent/guardian to compete in the above mentioned events. The above signed parent/guardian hereby consent to the applicant's participation and waive and release rights and claims for damages as is more fully set forth above. Signature: _________________________________________________ Date: ________________