Big Brothers Big Sisters of Shelby & Darke County Presents the: 9th Annual Duck N’ Run 5k *Walkers and Waddlers Welcome* June 18th, 2015 Registration begins at 7:00pm at Geib Pavilion race starts at 8:15pm @ Tawawa Park in Sidney, OH This race is part of the Shelby County 5K Tour Register on-line at www.goodtimesraces.com New this year: Register before 5/4/15 and get into a drawing for a $50 Amazon Card Awards: Awards will be given to the top three male runners overall and top three women runners overall. There will be medals to top three places of each age group, male and female. Award ceremony will begin at 9:15 PM. Door prizes will be drawn during the race and be available after running. Refreshments at finish line for all runners/walkers. Restroom facilities are available within the park. Male & Female Divisions: 10&Under 25-29 45-49 11-14 30-34 50-54 15-19 35-39 55-59 20-24 40-44 60-64 65-69 70-74 75-79 80&Over Please cut and return this portion to address on bottom of form Name: __________________________________________________Age (as of 12/31/15): _________ D.O.B.: ___________ Address: _____________________________________________ City, State, Zip: ____________________________________ Phone Number: (____)____-______________Email: ___________________________________________________________ Team Name: (optional) ________________________________________________ Circle One: Male Female T-Shirt Size (if applicable, circle one) Youth L S M L XL XXL Check one of the following: Pre-registration must be post marked 6/1/15  Pre-register with t-shirt & 1 duck adoption $25  Pre-register with t-shirt $20  Pre-register just the 5k $12 Note: By registering with a duck adoption, you are also entered into the Daffy Derby duck drop that will occur at 7:30 pm in the stream adjacent to Geib Pavilion. T-Shirts can be purchased dayof for $10 if supplies allow.  Wheelchair/Stroller Entrant (no extra fee)  $15 Day of registration (does not include a T-shirt) In consideration for my being permitted to participate in the Big Brothers Big Sisters Duck N Run 5K run, I hereby release, discharge and agree to hold free and harmless the BBBS Committee, Rocketship Sports Management, Good Times Event Services LLC, Event Sponsors, Sidney City TWP. Park and its committees and any volunteers and each of them together with their successors, assigns, officers, agents and employees from any and all liability for injuries to property or person suffered by me as a result of my participation in Big Brothers Big Sisters Duck N Run 5K run. By my execution of this waiver, I verify that I am physically fit and have sufficiently trained for the completion of this event and a licensed medical doctor has verified my physical condition. I also verify the age I put down will be the age I will be on December 31, 2015. This release shall be binding upon my heirs, executors and administrators. REFUND: I also agree that my entry fees, once paid, are non-refundable. I have read the entry form and certify compliance by my signature. Race registrant signature ____________________________________________________ Parent/Guardian (if under 18) _______________________________________ _____________________ Date: __________________________________________ _____(Check if interested) I am considering becoming a BIG Sister or Brother for a child in Shelby or Darke County. Mail Pre-Registration Form & Payment (must be postmarked by June 1st) to: Big Brothers Big Sisters of Shelby & Darke County Attn: BBBS Duck N’ Run 5k . P.O. Box 885 , Sidney Ohio 45365