5K Race / Walk and Kids Fun Run Saturday, May 16, 2015, 9:30 AM Sponsored by Williston Families as Partners (FAP). Proceeds fund programs to benefit Williston students and teachers. Presented by: Race Location: Williston Central School, 195 Central School Dr., Williston • 8:00 - 9:15am - Race day registration & packet pickup • 9:30 am – Kids Fun Run Start • 10:00 am – 5K start (Walkers start after runners) • 11:00 am - Awards ceremony, raffle prize drawing & entertainment • 12:00 pm - Event concludes 5K Age Groups: Male/Female - 14 & under, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70+. Awards & Prizes: Awards to 5K male & female age group winners, team awards, and raffle prize drawing. Course Description: There are two distance options for the Kids Fun Run (1 Loop Results: Final race times will be listed in the or 2 Loops) around the gravel track behind Williston Central. The 5K course Williston Observer, School Bell and on the Williston starts on the bike path and finishes behind Williston Central School. For a Runs for Education website at willistonruns.org. detailed 5K course description go to www.willistonruns.org. Save time - register online at www.willistonruns.org Register by May 11 and be automatically entered into the preregistered prize drawing! or complete one form per participant Return completed forms with payment to the Main Office at Williston Central or Allen Brook School or mail to: Williston Runs! c/o FAP, 195 Central School Dr., Williston, VT 05495 Name: _____________________________________________________________ Phone: ___________________________________ E-mail: _____________________________________________________ Age on race day: ______________ ☐ Male ☐ Female Individual Entry (select one): ☐ 5K Run ☐ 5K Walk ☐ Kids Fun Run 1 Loop (1/3rd mile) ☐ Kids Fun Run 2 Loops (2/3rd mile) Anyone covering the course on a bike, scooter, skateboard, rollerblades etc., MUST WEAR A HELMET TO PARTICIPATE! 5K Run - 3 Person Team Entry: (Note: no race-day registration for teams) Team Name: ________________________________________________ Captain’s Name: ____________________________________________ Team Member Names:_______________________________________ _____________________________________________________________ Team Type: ☐ Family ☐ School ☐ Business/Sponsor ☐ Other Entry Fee: Kids/Students 13 and younger - $7.00 ($10 day of race) $ __________ Adults - $12.00 ($15 day of race) $ __________ 3 Person Teams ($10 each member) $ __________ Raffle: All registered participants automatically receive 1 raffle ticket. You may purchase additional tickets for a better chance to win cool prizes! EVENT CONTACT: Sue Scheer 238-2474 [email protected] 1 ticket ($1.00) $__________ 6 tickets ($5.00) $__________ 10 tickets ($7.00) $__________ THANK YOU for supporting education! TOTAL: (please make checks payable to “Williston FAP:) $__________ Athlete Waiver and Release of Liability/ Photo Release – Must be signed to participate I know that walking/running/riding in a race is a potentially hazardous activity and that I should not walk/run/ride unless I am medically able and properly trained. I assume all the risks associated with walking/running/riding in this event. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I for myself, and anyone entitled to act on my behalf, waive and release the Town of Williston, Williston Central School, Allen Brook School and the Williston FAP, and all sponsors, their representatives and successors, for all claims or liabilities of any kind arising out of my participation in the Williston Runs for Education event. grant permission to be photographed, video taped and recorded for all media usage. Participant Signature : __________________________________________________________________ Date: __________________ (Parent/Guardian must sign if participant is under age 18)
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