12th Annual Saturday, September 5, 2015 Raising Funds for The Arc of Howard County, Inc. FISH of Howard County, Inc. The Shrine of St. Anthony and Other Local Charities 8:00 A.M. SAVE THE DATE On the grounds of The Shrine of St. Anthony, Ellicott City, Maryland Race Course Information: The 10K race starts and finishes at the Shrine of St. Anthony, 12290 Folly Quarter Road, Ellicott City, Maryland 21042. It takes you through scenic western Ellicott City countryside and surrounding neighborhoods. It is USATF Certified: MD07010JS, and is open to traffic. The 5K race also starts and finishes at the Shrine. The first half is on Folly Quarter Road and the second half is through rough terrain on the Friary premises. The ¾ mile Fun Walk is entirely on the premises, as is the ¾ Mile Fun Run for children age 12 and under. Race Day Information: Saturday, September 5, 2015 (Rain or Shine) 6:45 Race Day Registration & Packet Pick Up 8:00 10K & 5K Races 8:05 ¾ Mile Fun Walk & ¾ Mile Kids Fun Run Additional Information: Go to www.kc11898.com for more on the race. Awards/Amenities: 1st, $75; 2nd, $50; 3rd, $25 to the first three men and women in the open division for both the 10k & 5k races. Non-cash awards in 7 age group categories. Lots of activities including food, music, moonbounce, massages, and random prize giveaways. T-Shirts: Guaranteed to participants registered by August 13th with maximum 4 per family registration. Event Management/Timing: www.bullseyerunning.com Race Director: Doug Angradi 410-531-7594 knightsofcolumbus10krun@verizon.net 2014 Sponsors 2014 Concetta Corriere & Jim Jeppi Realtors RE/MAX 100 ♦ Dixon Hughes Goodman LLP - CPA's and Advisors Donald J. Enright - Long & Foster ♦ Commercial Construction ♦ Clarks Ace Hardware ♦ Sandy Spring Bank Juice Plus+ ♦ Boarman’s Meat Market ♦ AutoStream Car Care ♦ Safeway, Inc. ♦ Clarksville Exxon ♦ Wegmans Entry Form – Please print clearly Fees (non-refundable): Pre-registration (postmarked by Aug. 13) Individual - $25.00 Family up to 4 - $55.00 Kid’s FR - $10 Regular Registration (postmarked by Aug. 29) Individual - $30.00 Family up to 4 - $65.00 Kid’s FR - $10 Late/Race Day Registration Individual - $35.00 Family up to 4 - $75.00 Kid’s FR - $10 Please accept my contribution of $_______ Does your employer provide matching funds? Yes No Additional T-shirts, _____ at $10 each; add $2 for each XXL $_______ Complete and return form with payment to: Knights of Columbus Charity Fund P.O. Box 85 Clarksville, MD 21029 Total: $_______ Name ____________________________________ 10K 5K Walk Kids Official Use Only Address ___________________________________________________________ A City ___________________________________ State ______ Zip _____________ Age _______________ DOB ____________________ Male Female Home Phone _________________________ Email ___________________________________ List ALL names of additional participants: Sex Event 2._______________________________________ _____ ___________ M/F 10 / 5 / W / K 3._______________________________________ _____ ___________ M/F 10 / 5 / W / K 4._______________________________________ _____ ___________ M/F 10 / 5 / W / K T-Shirt Size(s): (one per individual/four per family, plus paid additional): Youth: _____ YM Adult: _____ S _____ M _____ L Age _____ XL DOB _____ XXL (add $2) None: _____ Liability Waiver: I know that running a road race is a potentially hazardous activity and that I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event, including, but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of you accepting my entry, for myself and anyone entitled to act on my behalf, I waive and release organizers of the Ellicott City Labor Day Running Classic 10K & 5K, Knights of Columbus, Franciscan Friars, Race Director, volunteers, and all sponsors of all claims, damages, demands and any action whatsoever in any manner arising from my participation in said athletic event. I attest and verify that I have full knowledge of the risks involved in this event. Further, I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for legitimate purposes. If under 18, parent or guardian’s signature 1. _______________________________________________ Date ___________ 3. _______________________________________________ Date ___________ 2. _______________________________________________ Date ___________ 4. _______________________________________________ Date ___________
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