presents 2nd Annual 5Kerry 5K Trail Run Saturday, November 29, 2014 HOYT FARM NATURE PRESERVE 200 New Highway, Commack, NY Start 11:30 am. Check in begins 9:30am Race Timed by Long Island Race Timing Prizes T shirts Register online with Active.com or mail form below postmarked by November 15 169 Commack Road Suite H171 Commack, NY, 11725 Preregistration fee: $20 Race Day: $25 Teams of 10+: $15/person Donations are tax free Music by DJDK Readings by Psychic Medium Nancy D’Erasmo The Kerry Rose Foundation 5Kerry 5K Trail Run $20 Preregistration Fee is enclosed I am unable to attend but enclosed is a donation Circle One: M/F s/m/lg/xl Run/Walk Name__________________________DOB:________ Address____________________________________ City______________________State____Zip_______ Phone______________E-mail___________________ I, the undersigned, intending to be legally bound , hereby, for myself, my, heirs, my assigns, executors, and administrators, waive and release any and all claims for damages I may have against the Kerry Rose Foundation, and all other sponsors of the 5Kerry , the State of New York, the Town of Smithtown, and their employees, agents, representatives, successors and assigns, from any and all liabilities, claims, demands and causes of action whatsoever arising directly or indirectly from my participation in the event, even if such liabilities, claims, demands and causes of ac tion arise in whole or in part out of the negligence of any of the above-mentioned organizations or individuals. I attest and verify that I am physically fit and have trained sufficiently for the competition of this event, and that my physi cal condition has been verified by a licensed Medical Doctor. If signed by a parent, the parent agrees to release and hold the above named organization and personnel harmless from and against any claims and rights, which may be asserted on behalf of the entrant. I hereby grant permission to any and all of the foregoing organizations and personnel to use photographs, or any other record of this event for any purpose whatsoever. Signature_______________________ Parent Signature_________________