a registration form

PO Box 1587
Cranberry Twp, PA 16066
Sponsored by FedEx Ground
Every child needs a hero
but abused children need superheroes
The 7th Annual
1K or 5K Run/Walk
ro
Every child needs a he
ed superheroes
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n
but abused childre
Schedule of Events
Thursday, April 23rd
Packet pick up Mojo running 4-7pm
Friday, April 24th
TBD right now
Saturday, April 25th
8:00 AM: Race Day Registration
9:30 am: 1K Fun Run
9:45 am: 5K Run
10:00 am: 5K Walk
Benefitting:
Saturday, April 25, 2015
9:30 a.m.
CASA
of Allegheny
County
North Park Pool Loop
(S. Ridge Road at Hemlock Drive)
Fees
5K – $25 before 3/31/15
1K – $15 before 3/31/15
Family 5K (up to 5 family members) – $95
before 3/31/15
Family 1K (up to 5 family members) – $55
before 3/31/15
Register by 3/1/15 to receive a tek shirt
or by 3/31/15 to receive a t-shirt.
Proceeds
All proceeds from The Superhero Run benefits CASA
Registration close date is April 20th
We encourage everyone to come in a costume!
www.superherorun.org | pittsburgh@thesuperherofoundation.org
About Casa
CASA (Court Appointed Special Advocates) of Allegheny County works to recruit, train and supervise community volunteers
who advocate for abused and neglected children in court and throughout the child welfare system. In our community, there
are thousands of children who are active with the Children’s Court system because they have been abused or neglected.
Unfortunately, child victims often suffer from a myriad of complex problems and circumstances that, without personalized
attention, will sabotage their ability to find safe, nurturing and permanent homes. CASA volunteers and their staff case manager
partner together to ensure that every child receives the personalized attention they need and deserve. For more information on
CASA, or to find out how you can become a CASA volunteer, please visit www.pgh-casa.org.
About Us
The Superhero Foundation is a group dedicated to the crusade against child abuse.
April is National Child Abuse Prevention Month. We seek to raise awareness for this,
and to ensure that every state recognizes April as Child Abuse Prevention & Awareness
Month. We also support various regional organizations that help in the battle against
child abuse, and those that support the rehabilitation of abuse victims.
Our Sponsors
RCB ASSOCIATES
RCB
ASSOCIATES
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Registration Form
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All participants must register. One form per family.
NAME
STREET ADDRESS
CITY, STATE, ZIP
Please list all participating family members below
Name
Adult #2
I will be participating in the: (circle one)
1K
5K Runner
5K Walker
Child
Work
Friend
CASA
D.O.B.
(Required)
Child
Where did you find out about the race?
Twitter
T-Shirt size
YS,YM, S,
M, L, XL
XXL-$2 xtra
Adult #1
PHONE/Email
Facebook
5K Walk
5K Run
1K Fun Run
Child
School
Previous Participant
Radio
Other
Child
Child
Signature (Adult #1)
Parent/Guardian signature if under 18 years old
Signature (Adult #2)
Parent/Guardian signature if under 18 years old
I attest that I am physically fit and sufficiently trained to participate in this event. I have full knowledge of the risks involved. Therefore, in consideration of my entry in the Pittsburgh
Superhero Run, I for myself, my heirs, my executors and administrators waive any and all rights and claims I may have against The Superhero Foundation, Court Appointed Special
Advocates of Allegheny County. (also known as CASA of Allegheny County), North Park and its agents, affiliates and employees, all sponsors, and any individuals associated with
this event and will hold them harmless for any and all injuries, damages or death I may suffer in conjunction with this event. I further grant permission for the releasees to use any
photographs, moon picture recordings or any other record of the event containing my name, likeness or performance. If a parent is signing on behalf of a minor, then the parent
agrees to defend and indemnify any claim brought against them by that minor at any me, arising out of the minors participation in this event. I have carefully read this Release and
Assumption of Risk and fully understand its contents. I voluntarily agree to it and realize that this will bind me, my heirs and my personal representatives. As the parent/guardian of
participant/s under 18, I agree to all the terms of this release for the child I have registered. Parent or legal guardian must initial if under 18.
Subtotal:
__YS __YM __S __M __L __XL __XXL Additional Cotton Shirt ($5):
__YS __YM __S __M __L __XL __XXL Additional Tek Shirt until 3/1/15 ($10):
Additional Donation to the Superhero Foundation:
Total (all fees non-refundable, please enclose fee with registration form):
Check Payable to: The Superhero Foundation
Po Box 1587 Cranberry Twp, PA 16066
Fees
(see Front
for rates)