STEP INTO SPRING FUN RUN
WHO: YOU!
WHAT: STEP INTO SPRING FUN RUN 5K, 1 MILE, 1⁄4 MILE and 100 YARD DASH
WHEN: Sunday, April 29th at 1:30 pm Awards presentation to follow after last walker crosses finish line.
WHERE: Event will start at the Geneseo Middle School 333 E. Ogden Ave., Geneseo, IL 61254
Registration Information
Adults (18 years and older) $18 with a shirt or $13 without a shirt (add $2 for XXL and up) Child $10 with a shirt and $5 without a shirt 5K ~ 1 Mile ~ 1/4 Mile ~ 100 Yard Dash Participants **All participants registered after April 20th will NOT be guaranteed a shirt on race day** Packet Pick Up/Late Registration will be at Geneseo Middle School: Saturday, April 28th 11:00am–2:30pm and Sunday, April 29 9:00am– 12:30pm **If you do not wish to participate in the event: Donations of $25 or more will receive a free 5k Fundraiser T-shirt!**
Official Entry Form, Please detach and mail form with a check payable to: Geneseo Elementary PTA To: Geneseo Elementary PTA 5K, 415 North Russell, Geneseo, IL 61254 Or send the form in to one of the Geneseo Elementary Schools c/o PTA 5K Or register on-line (after Jan. 26th) at www.cornbelt.org or www.getmeregistered.com Any Questions? Email us at: stepintospring5K@gmail.com
Please circle one: 5k 1 mile 1⁄4 mile 100 yard dash Donation Only Circle shirt size: YXS YS YM YL S M L XL XXL XXXL First Name: ______________________Last Name: ___________________________ Address:___________________________City:__________________State:______ Email:_____________________________ Date of Birth:____________mm/dd/yy Age:________ CIRCLE: M or F Phone#:__________________
WAIVER. I know that participation in a road race is potentially hazardous. I should not enter and run or walk unless I am able and properly trained. I know that, although police protection may be provided, there may be traffic on the course route. I assume the risk of running or walking along the route. I also assume any and all other risks associated with participation in this event, including but not limited to falls, contact with other participants, the effects of weather, including high heat and/or humidity and cold temperatures, and conditions of the route, all such risks being known and appreciated by me. I attest and verify that I am physically fit and sufficiently trained for the completion of this event. I also authorize First Aid and/or treatment to be rendered in case of any emergency. I hereby consent to and authorize the use and reproduction, in print or electronic format, by the Geneseo Elementary PTAs or anyone authorized by the Geneseo Elementary PTAs, of any and all photographs which have been taken on this day for any publicity purposes without compensation. I also understand, in which case the Race Directors deem the weather conditions to be unsafe for the start or continuation of the race, that the race may be postponed or canceled. Should I choose to stay on the racecourse, I do so at my own risk. All entry fees are non-refundable. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act for my behalf, waive and release the Geneseo Elementary PTAs, and all sponsors of the event, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability might arise out of negligence or carelessness on the part of the persons named in this waiver.
________________________________________________________ __________________________________ Signature (Parent’s if under 18) Date
STEP INTO SPRING FUN RUN
for the