PHASD Endowment Fund Fun Run “K’s For Kids” 5k/1Mile May 16, 2015 Registration time: 7:30 a.m. Race Start Time: 1 mile at 8:30 a.m., 5K at 9 a.m. Place: 4475 24th Ave. Fort Gratiot, MI 48059 (Fort Gratiot Trail behind Meijer) Fees: $25 per runner, $30 after March 31, $35 on race day **Run for free when you confirm a pledge of $30 • Medals for Top 3 in each division per gender will be awarded • Tech Shirt will be given for registered runners (Guaranteed up to May 9, 2015) • All proceeds benefit the PHASD Endowment fund. SIGN UP Today’s Date: ____________________________ NAME (print): ________________________________________ Date of Birth: ____________________________________ Male: ____ Female: ____ ADDRESS: _________________________________________________________ Phone number: __________________________ Email: ________________________________________________ RACE: 5K: _____ 1 mile: _____ PAYMENT: Check enclosed (payable to PHASD Endowment Fund) I have a $30 pledge/donation: ____ AMOUNT: $____ WAIVER: In consideration of you accepting this entry, I, the participant, intending to be legally bound and hereby waive or release any and all rights and claims for damages or injuries that I may have against the Event Director, RunSignUp.com, and all of their agents assisting with the event, sponsors and their representatives and employees for any and all injuries to me or my personal property. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees. I certify as a material condition to my being permitted to enter this race that I am physically fit and sufficiently trained for the completion of this event; that my physical condition has been verified by a licensed Medical Doctor. By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to the above waiver. Accept waiver signature: _______________________________________________