Kent County Girls on the Run 5K Celebration Adult Registration Form Come support Girls on the Run by participating in the Celebratory 5K event. May 16, 2015 at Calder Plaza at 9:45am. This race is not timed. Name _________________________________________________________________ Address________________________________________________________________ DOB (dd/mm/yyyy) ______________ Age on Race Day: ________ Sex: M / F Email Address___________________________________________________________ Shirt Size Selection: No Shirt Small Medium Large XL Must be 16 or older on Race Day to Participate 2XL Emergency Contact Name __________________________________________ Registration P5K Adult Registration by May 11 ($28) Register by April 12 to guarantee event t-shirt Additional Donation Total: _______________ Phone: _______________ After May 11, registration is only available online or at packet pickup ($30) Would you like a receipt? (Please Circle One): Yes No How will you participate in the Celebration 5K? (please select one): PAdult runner, participating without a girl PI plan to participate with my daughter PPlan to participate with a girl and have been designated by the girl’s parent or guardian PCommunity volunteer and would like to be assigned as a Running Buddy to a team or girl Must contact Nika at program.kcgotr@gmail.com for background check If you are running with your daughter or have been designated to run with a specific girl by her parent or guardian please indicate below. Name __________________________________________ School_________________________________ Waiver: In consideration of my participation in the 2015 Kent County Girls on the Run Celebratory 5K Run (‘The Event’), and with the understanding that my participation in the Event is only on the condition that I enter into this agreement for myself, I hereby assume the risk and accept full responsibility for any and all injuries (including death) and accidents which may occur as a result of my participation in this Event and release from liability Kent County Girls on the Run,Calder Plaza and any additional sponsors and each of their officers, directors, volunteers and employees. I hereby waive any claim I may hereafter have as a result of any and all injury to my participation in the Event. I hereby agree to indetinify all of the above-named parties for any and all claims, including attorney fees and costs, which may be brought against any of them by anyone claiming to have been injured as a result of any injury to me or my property which may occur as a result of the Event. I certify that I have read and am fully legally competent to make this agreement. Pay By: PCheck PCash (Checks can be made payable to KCGOTR) Mail this form to: KCGOTR - 5K 4835 Eastern Ave SE, Kentwood MI, 49508 Forms must be received by May 11 Signature ___________________________________________________ Date______________________