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EITAS
8511 Hillcrest Road
Kansas City, Missouri 64138
About Eitas
Eitas’ mission is to support individuals with developmental disabilities
and their families with services that respect their choices, increase
their opportunities, encourage their independence, and assist their
inclusion in all aspects of the community. In 2011, eitas was noticed
and awarded the Cutting Edge Award for being leaders and mentors in
Gentle Teaching.
Michael’s Story
This event is dedicated to the loving memory of Michael Haseltine;
Father, Grandfather, Advocate for individuals with developmental
disabilities, and previous Deputy Director of Developmental Disability
Services of Jackson County - eitas. In November of 2009, eitas
unexpectedly lost one of our most valued members to leukemia.
Michael was with eitas for more than 12 years. Michael’s deep passion
and commitment for supporting persons with developmental
disabilities was contagious. His dedication and support to eitas and the
people we serve will always be remembered.
In memory of Michael, eitas has created a scholarship fund.
Scholarship proceeds will be used to assist college students whose
major studies focus on working in the Developmental Disability field
and to the individuals we support for pursuing a higher education.
Applicants apply annually, a committee will choose scholarship
recipients and the scholarship(s) will be awarded at the eitas Annual
Awards presentation in April of each year. If interested in applying
for the scholarship, visit: www.eitas.org OR www.gkccf.org.
Sponsorship Information
Diamond: $5,000 donation
 Logo on up to 3 KC area billboards
 Recognition and 7 seats at Eitas’ Annual Awards Banquet
 Logos included on all printed and press materials
 Logo on Eitas website and event t-shirt
 Banners displayed at event (company provides banner)
 10 complimentary race registrations and t-shirts
 PA announcements at event awards ceremony
 Race packet inserts and vendor booth at race
Platinum: $2,500 donation
 Logos included on all printed and press materials
 Recognition and 3 seats at Eitas’ Annual Awards Banquet
 Logo on Eitas website and event t-shirt
 Banners displayed at event (company provides banner)
 5 complimentary race registrations and t-shirts
 PA announcements at event awards ceremony
 Race packet inserts and vendor booth at race
Gold: $1,500 donation
 Logo on Eitas website and event t-shirt
 Banners displayed at event (company provides banner)
 PA announcements at event awards ceremony
 Race packet inserts and vendor booth at race
Silver: $1,000 donation
 Logo on event t-shirt
 Banners displayed at event (company provides banner)
 Race packet inserts and vendor booth at race
Bronze: $500 donation
 Logo on event t-shirt
 Race packet inserts
 Vendor booth at race
Contact Amy Allen at (816) 595-6324, Sarah West at (816) 595-8264 or Shannon
Maloney at (816) 595-8270 for additional information. Vendor spots are available for
$25 for non-sponsors.
Race Map
Location/Directions
th
The 4 Ability 5K Run, Walk, & Roll will be held in Swope Park in
Kansas City, Missouri at the Bandstand off Starlight Drive. Entrances
are available at 63rd Street (KC Zoo entrance) or Swope Parkway and
Meyer Blvd.
NOTE: Swope Parkway and Meyer Blvd. entrance will be closed at 7:30am in
preparation for the start of the race.
Parking
Accessible parking is available closer to start/finish line. All parking
is on a grass lot. Parking attendants will direct all traffic starting at
6:15am.
Runner Protection & First Aid
During the event, roller skates, in-line skates, hand/foot cycles or
scooters are not allowed. Minor first aid will be available during the
event.
Race Day Information
Date:
6:30a.m.
8:00a.m.
8:15a.m.
8:50a.m.
9:15a.m.
Saturday, March 28, 2015
Race Day registration
5K Run/ 1 mile Walk
1 Mile Roll starts
Tot Trot. The Tot Trot is free to
our youngsters 10 yrs old and under.
Awards Ceremony
NOTE: Placement awards given to overall finisher of the 5K event and top finisher
of age groups.
Volunteers
Volunteers are needed for race day activities. No previous experience
needed. Contact Melissa Bryant for more information at (816) 5956316.
Entertainment
Bring the family to enjoy a morning filled with lots of activities.
Enjoy entertainment from mascots, face painters and much more!
Pets
Race Registration Information
The only pets allowed will be those that are certified assistant pets.
RACE FEES
December 1st – March 17th - $25
Questions
If you have questions about the 3rd Ability 5K Run, Walk, & Roll
please email 5krunwalkroll@eitas.org
Packet Pickup
Packet pickup will be available March 26th & 27th at eitas located at
8508 Hillcrest Road, Kansas City, Missouri 64138.
March 18th – 20th - $35
Race Day - $40
Register In Person
Participants can register at eitas located at 8511 Hillcrest – Suite 300,
Kansas City, Missouri 64138 through March 20, 2015 by 4:30 pm.
Thursday, March 26th: 8:00am-6pm / Friday, March 27th: 8a-6pm
Register Online
*******NO PACKET PICK-UP ON RACE DAY! !!**********
Participates can register online at www.eitas.org OR
www.enter2run.com until March 20th.
Register by Mail
Participants can send completed entry forms with payment to the
EITAS, 8511 Hillcrest Road, KCMO 64138. MUST be postmarked by
March 20, 2015.
Race day registration
Participants can register the day of the race starting at 6:30 am located
at the Swope Park Bandstand. Packets will be available for those
registering that day.
Group Rates:
December 1st – March 17th Group of 5 - $100
March 18th – 20th Group of 5 = $125
Race Day Group of 5 = $150
4th Ability 5K Run, Walk, & Roll
First/Last Name (print)__________________________________________________________
Address (City/State/Zip)_________________________________________________________
Phone number: _____________________________________ Age on Race Day ____________
Email Address: _________________________________________________________________
Gender:
Male
Female
Circle which route you will be running/walking:
5K Route
1 Mile Route
Registration Fees: (check one)
Individual Rate:
December 20 – March 17th = $25
Group Rates (groups of 5):
March 18th-20th = $35
Dec. 20 – March 17th = $100
March 18th – 20th = $125
I am an individual supported by eitas or KCRO and have included my $5 entry fee with
this registration form.
Adult sizes: S(Qty.#___)
Youth sizes: S (Qty.#___)
M(Qty.#___)
M(Qty.#___)
L(Qty.#___)
L (Qty.#___)
XL(Qty.#___) XXL (Qty.#___) XXXL(Qty.___)
XL(Qty.#___)
(*Race day entries cannot be guaranteed a t-shirt)
Additional shirts: $15 adults: ___size ___quantity
$10 youth: ___size ___quantity
Release & Waiver
Please check the box that applies to the applicant. By checking one of these boxes I hereby
give and make all of the representations, covenants, and agreements set forth in the
applicable Release and Waiver Agreement.
Adult Release and Waiver
Child Release and Waiver
_______________________________________________________
Participant Signature
Date
_______________________________________________________
Parent/Guardian Signature
Date
How did you find out about this event? ___Website ___ Flyer ___ Billboard ___ Other
Adult Release and Waiver of Liability
I am signing this Agreement because I want to participate in the 4th Ability 5K Run, Walk and Roll (the “Road Race”). I acknowledge that
participation in the Road Race will involve, without limitation, running in vehicular traffic on the course route and the possibility of being struck
by a vehicle, the possibility of collision with other participants, running on road surfaces that are not properly maintained or are inherently
unsafe, being exposed to the prevailing weather (which may cause road surfaces to be unsafe), the potential for falls, and the potential for a
heart attack or other damaging health event attributable to strenuous activity, and that such participation is generally an inherently dangerous
and hazardous activity. I understand the risk that I or other participants in the Road Race might become ill, be injured, or die, and I understand
the risk of damage to property, mine or others, that arise from participation in the Road Race. Nonetheless, I assume full responsibility for all
such risks. I am in good health, and I know of no reason why I am not capable of participating safely in the Road Race. I agree to abide by all
decisions of Road Race officials relative to my ability to safely complete the Road Race.
I agree to observe and comply with all Road Race rules and regulations, whether posted on the Road Race course or elsewhere, and I
agree to comply with all decisions and requests of Road Race officials. Without limiting the generality of the preceding sentence, I understand
that no headsets, roller skates, dogs, skateboards or motorized vehicles are allowed on this course, and I agree to these restrictions. If pushing
a stroller in the Road Race, I will start behind the other participants and walk only.
In consideration of the opportunity to participate in the Road Race, I, on behalf of myself and my heirs and personal representatives,
hereby covenant not to sue regarding and waive any and all claims against Developmental Disabilities Services of Jackson County - EITAS and
Kansas City, Missouri (including the Kansas City Police Department), which are the principal sponsors of the Road Race (the “Principal
Sponsors”), all elected officials, directors, officers, and employees of such Principal Sponsors (the “Principal Sponsor Personnel”), all volunteers
who work at the Road Race (the “Volunteers”), and all persons who make donations or sponsorship payments in support of the Road Race (the
“Race Sponsors”) for or relating to any illness or injury that I might suffer, for my death, and for any damage to my property that may arise or
result from or that relates in some way to my participation in the Road Race. In addition, I, on behalf of myself and my heirs and personal
representatives, hereby release and forever discharge the Principal Sponsors, the Principal Sponsor Personnel, the Volunteers, and the Race
Sponsors from liability for any such claims or demands, regardless of the negligence of any such person. I intend for this waiver, release, and
discharge to be as broad and inclusive as applicable law permits.
I grant permission to each of the Principal Sponsors to use my name and likeness in any photographs, videos, recordings, or any
other record of the Road Race, royalty-free and in perpetuity, in advertising, promotional, informational, or marketing materials related to such
Principal Sponsor and its mission.
Child (Minor) Release and Waiver of Liability
I am the parent or guardian of the minor child whose name appears below (“Child”), and I am signing this Agreement because I want my Child
to participate in the 4th Ability 5K Run, Walk and Roll (the “Road Race”). I acknowledge that participation in the Road Race will involve my child
in, without limitation, running in vehicular traffic on the course route and the possibility of being struck by a vehicle, the possibility of collision
with other participants, running on road surfaces that are not properly maintained or are inherently unsafe, being exposed to the prevailing
weather (which may cause road surfaces to be unsafe), the potential for falls, and the potential for a heart attack or other damaging health
event attributable to strenuous activity, and that such participation is generally an inherently dangerous and hazardous activity. I understand
the risk that my Child or other participants in the Road Race might become ill, be injured, or die, and I understand the risk of damage to
property, belonging to my Child or others, that arise from participation in the Road Race. Nonetheless, I assume full responsibility for all such
risks. My Child is in good health, and I know of no reason why my Child is not capable of participating safely in the Road Race. I agree to abide
by all decisions of Road Race officials relative to my Child’s ability to safely complete the Road Race.
I agree that my Child will observe and comply with all Road Race rules and regulations, whether posted on the Road Race course or
elsewhere, and I agree that my Child will comply with all decisions and requests of Road Race officials. Without limiting the generality of the
preceding sentence, I understand that no headsets, roller skates, dogs, skateboards or motorized vehicles are allowed on this course, and I
agree that my Child will comply with these restrictions.
In consideration of the opportunity for my Child to participate in the Road Race, I, on behalf of myself, my Child, me and my child's
heirs and personal representatives, hereby covenant not to sue regarding and waive any and all claims against Developmental Disabilities
Services of Jackson County - EITAS and Kansas City, Missouri (including the Kansas City Police Department), which are the principal sponsors of
the Road Race (the “Principal Sponsors”), all elected officials, directors, officers, and employees of such Principal Sponsors (the “Principal
Sponsor Personnel”), all volunteers who work at the Road Race (the “Volunteers”), and all persons who make donations or sponsorship
payments in support of the Road Race (the “Race Sponsors”) for or relating to any illness or injury that my Child might suffer, for my Child’s
death, and for any damage to me or my Child’s property that may arise or result from or that relates in some way to my Child’s participation in
the Road Race. In addition, I, on behalf of myself, my and my child's heirs and personal representatives, hereby release and forever discharge
the Principal Sponsors, the Principal Sponsor Personnel, the Volunteers, and the Race Sponsors from liability for any such claims or demands,
regardless of the negligence of any such person. I intend for this waiver, release, and discharge to be as broad and inclusive as applicable law
permits.
I grant permission to each of the Principal Sponsors to use my Child’s name and likeness in any photographs, videos, recordings, or
any other record of the Road Race, royalty-free and in perpetuity, in advertising, promotional, informational, or marketing materials related to
such Principal Sponsor and its mission.