“K's For Kids” - Port Huron Schools

 PHASD Endowment Fund Fun Run
“K’s For Kids”
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.
Today’s Date: ____________________________
NAME (print): ________________________________________
Date of Birth: ____________________________________
Male: ____ Female: ____
ADDRESS: _________________________________________________________
Phone number: __________________________
Email: ________________________________________________
RACE: 5K: _____ 1 mile: _____
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
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: _______________________________________________