5K & Fun Run/Walk Runner Registration

12893 Kaufman Avenue NW, Hartville, Ohio 44632 • (330)877-2049

Runner Registration

Saturday, August 21, 2010
8 a.m. Fun Run/Walk; 8:30 a.m. 5K

Please complete the following information. Your maximum rate will be the 5K family rate of $55.

Primary Contact Information
First Name:	Last Name:
Address Line 1:	Address Line 2:
City:	State:	Zip Code:
Email:	Phone:
Runners I am registering and paying for: (Please enter your name again for the first runner)
Runner #1 Name: 5K ($15) 1 Mile Fun-Run ($10) Gender: Male Female Age on Race Day: T-Shirt Size Child S M L Adult S M L XL XXL	Runner #2 Name: 5K ($15) 1 Mile Fun-Run ($10) Gender: Male Female Age on Race Day: T-Shirt Size Child S M L Adult S M L XL XXL
Runner #3 Name: 5K ($15) 1 Mile Fun-Run ($10) Gender: Male Female Age on Race Day: T-Shirt Size Child S M L Adult S M L XL XXL	Runner #4 Name: 5K ($15) 1 Mile Fun-Run ($10) Gender: Male Female Age on Race Day: T-Shirt Size Child S M L Adult S M L XL XXL
Runner #5 Name: 5K ($15) 1 Mile Fun-Run ($10) Gender: Male Female Age on Race Day: T-Shirt Size Child S M L Adult S M L XL XXL	Runner #6 Name: 5K ($15) 1 Mile Fun-Run ($10) Gender: Male Female Age on Race Day: T-Shirt Size Child S M L Adult S M L XL XXL
How did you hear about the 5K & Fun-Run? (Please check all that apply) LCCS Lake Center Student (please give name: ) Newspaper Radio Friend Mail Website Other (Please comment)	Payment Options: I will pay for my registration on the day of the race. I will mail my registration fee to Lake Center Christian School, Attn: LCCS 5K & Fun-Run, 12893 Kaufman Avenue NW, Hartville, OH 44632.

Waiver & Release
I, the undersigned, realize that running a road race is a potentially hazardous activity. I should not enter & run unless I am medically able and properly trained. I agree to abide by any decisions of a race official relative to safely completing the run. I assume all risks associated in running this event including, but not limited to, falls, contact with other participants, the effects of the weather, traffic, and the conditions of the road, all such risks being known and approved by me. Having read this waiver, and knowing these facts, and in consideration of you accepting my entry, I for myself and anyone entitled to act in my behalf, waive and release Lake Center Christian School, Hartville, and all sponsors, their representatives and successors from all claims of liability of any kind arising out of my participation in this event. I hereby grant full permission to any or all of the foregoing to use any photographs, video tapes, motion pictures, recordings, or any other record of this event for any legitimate purpose. All race entries are non-refundable. We reserve the right to reject entries.
I understand and agree to the waiver and release (required).

Thank you for participating in the 2010 Lake Center Christian School 5K & Fun Run/Walk!