Anderson
Hills Kiwanis 5K Run/Walk at
(
Registration 7:00 am; Race starts
Awards and door prizes! Kids Fun Run!
Awards Divisions: Run - Men & Women: 14/under, 15-18, 19-24,
25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69 and 70/over Walk - Men & Women
29/under, 30-39, 40-49, 50-59, 60/over
Registration
Form Please print— one individual entry per form. Copy as needed.
For
more information visit—www.andersonkiwanis.com
First
name __________________________ Last
name ___________________________
Address
________________________
Home
Phone ______________ Work/Cell ______________ Email __________________________
Age
(on race day) ____ Gender:
Male Female Division: Walk Run
Shirt:
S M
L XL XXL
XXXL Pre-Registration
guarantees a shirt.
Pre-Registration
Deadline: post-marked by
PRE-REGISTRATION
COST INCLUDES T-SHIRT (Cost is $25.00
on Race day)
$20.00
Make
Check or Money Order payable to: Anderson Hills
Kiwanis Total
$_______
Mail
to: Anderson Hills Kiwanis,
WAIVER: In
consideration of the acceptance of my entry. I hereby waive on behalf on my
heirs, executors and assigns, all claims of any nature arising from my
participation in the Kiwanis 5K Run/Walk and do hereby release the coordinator,
Steve Prescott, the Anderson Hills Kiwanis, the Anderson Park District and
their boards, staff, and all sponsors, workers, officials, and volunteers and
all property owners along the race route from any claim whatsoever. I agree to abide by all the rules for
participation and acknowledge that the race committee may refuse or return my
entry at its discretion. I understand the risks for such an event, and have
trained adequately in preparation. I have noted any medical conditions on this
form. I also authorize the race coordinator, Steve Prescott, AHK, APD to publish any pictures taken before, during and after
the event for which I’ve registered.
Registrant’s
signature _______________________ Date ______________
Parent
signature also required for those under 18 ______________________
In
case of medical emergency contact _____________ Phone ____________
Any
known medical condition(s):