File - Tecumseh, Nebraska
Race Route TSCI WELLNESS “JUST FOR THE HEALTH OF IT” TECUMSEH STATE CORRECTIONAL INSTITUTION The TSCI Wellness Committee Presents BREAK OUT! APRIL 11, 2015 The 4th Annual TSCI Prison Break 5K Fun Run/Walk Mark Rumery Tecumseh State Correctional Institution PO Box 900 Tecumseh, NE 68450 Registration held at the The First Baptist Church Phone: 402-335-5114 E-mail: [email protected] April 11, 2015 @ 8:00 am Registration at 7:00 am The First Baptist Church Activity Center— 333 Jackson REGISTRATION FORM The TSCI Wellness Price List Name: Committee The TSCI Wellness Committee works towards creating health awareness and empowering the staff of TSCI and their families to make healthy life choices. The Committee provides information, hosts healthy option food days and facilitates activities to get people involved in healthy activities. The TSCI Prison Break 5K is another opportunity for the Wellness Committee to help people continue their work towards maintaining a healthy lifestyle and have fun doing it! TSCI’s Prison Break 5K _______________________________ Address: _____________________________ _____________________________ _____________________________ Entry Fee $20 (if paid by March 13th) $25 (After March 13th / day of the race) Early Participants will receive a tshirt and gift bag upon registration. Prizes for the overall male and female winner will be awarded. Door prizes will also be given out through random drawing of participants. Registration will start at 7:00 am in The First Baptist Church Activity Center- 333 Jackson St A reception area with drinks and snacks will be setup following the race. Phone: _____________________________ Email: ______________________________ Date of Birth: ____________ Age: _______ Gender: ______ Adult T-Shirt Size S M L XL XXL Other ________ Youth T-Shirt Size XS 2-4 / S 6-8 / M 10-12 / L 14-16 Other ____________ T-Shirts are not guaranteed for those that do not submit entry prior to March 13th Race will be held regardless of weather conditions. Registration is final. No refunds. Waiver: In consideration of the acceptance of this entry, I, the undersigned, assume full and complete responsibility for any injury or accident which may happen to me during the event know as the TSCI Prison Break 5K, and I hereby release and agree to indemnify, defend, and hold harmless the City of Tecumseh, sponsors, promoters, and all other persons or entities associated with this event from all injuries and damages, or otherwise. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, Return the entry form and fee to Mark Rumery Tecumseh State Correctional Institution PO Box 900 Tecumseh, NE 68450 Phone: 402-335-5114 E-mail: [email protected]
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