Registration form mountain view christian school 5k run/walk raising Scholarship Funding for Christian Education

RACE REGISTRATION FORM

MOUNTAIN VIEW CHRISTIAN SCHOOL 5K RUN/WALK

Raising Scholarship Funding for Christian Education

Mountain View Christian School, South Williamsport, PA
Directions: From Williamsport area: Turn left on Central Avenue in South Williamsport go 3-3.5 blocks

And turn Left onto Fleming Street

From South Williamsport US 15 Right onto Central Avenue go 3.5 blocks and turn Left onto Fleming Street

Questions: Please contact Shena Hakes via [e-mail] or [phone]

SUNDAY, OCTOBER 5, 2014 ~ REGISTRATION BEGINS AT 9:00AM AND 5K AT 10:00AM

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  T-Shirt included with Registration Fee (if you register the day of the race, T-shirt will only be included if correct size is available)
  

Timing and Scoring provided by Insta-Results Sponsored by

Entry Fee for 5K $30 ○ PENN DENT Paintless Dent Repair

Owner Bob Koch 570-419-5993

Post-Race: Refreshments and Awards ○ Hakes Handy Work

Owner Bill Hakes

AGE DIVISIONS AWARDS - plus many more!

11-19 40-49 70 and over Overall Male and Female

20-29 50-59 1^st and 2^nd Place per Age Division

30-39 60-69

Mail Registration Form and Payment to: Mountain View Christian School, 305 Fleming Street
South Williamsport, PA 17702 /Attention Frank Stahl

Make checks payable to: Mountain View Christian School (note 5K Run/Walk on the subject line)

Name: ________________________________________________________________________________________________

Street Address: _________________________________________________________________________________________

City/State/Zip Code: _____________________________________________________________________________________
Telephone: ____________________________________________________________________________________________
Gender (Circle One): Male Female Age on October 5^th: ___________________________________________
Are you (Circle One): Running Walking How did you hear of the Race? ____________________________
T-Shirt Sizes (Circle One): S M L XL
WAIVER
I know that running/walking is a potentially hazardous activity. I should not enter or run/walk this event 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/walk. I assume all risks associated with running/walking in the race including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity and/or the conditions of the trail; all such risks being known and appreciated by me. All fees are nonrefundable. Race will take place rain or shine. In the event of extreme weather conditions or some other unforeseen act of God that may prohibit the race, all fees are nonrefundable. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release the event, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. Registration will not be accepted without acknowledgment of waiver signature.
Signature: ________________________________________________________ Date: ____________________________
Parent or Guardian Signature is required if participant is younger than 18 years of age

Parent/Guardian Signature: ___________________________________________ Date: _____________________________