We Run By FAITH! 5k/Prayer Walk
Saturday,July 15, 2017
Cimarron Crossing Park
Registration 6:30 a.m. Race Start Time: 7:00a.m.
–Check for updates!
FirstName ______LastName______Address______
City ______State ______Zip Code______
Phone ______Email(willbeusedforupdatesontherace)______Dateof Birth______Age______Sex M F
Race
_____ 5 K
_____ Prayer Walk
ShirtSize (circle one)
Purple shirt SMLXL
ENTRYFEESFOR EARLYBIRD REGISTRATION:
5K - $25.00
Prayer Walk- $20.00
YSYMYL
Pre-registered runnersbyJuly 5,2016 will be guaranteeda t-shirt.*SWTFRmembersdeduct $2.00
REGISTRATIONAFTERJuly 5,2016:
5K - $30.00
Prayer Walk- $25.00
Shirts will befirst come firstserved
____ My Paymentisenclosed.(Make checkspayabletoSt. Stanislaus)
Mail registrationformto: Katrina Baker PO Box 114, Cimarron KS 67835; 620-874-2870
ONE ENTRYPERAPPLICATION •THIS MAY BE REPRODUCED •NO REFUNDS,EXCHANGESORTRANSFERS
EveryParticipantMustSignThisWavier!Parent/Guardianfor anyoneunder 18mustsignthewavier.I knowthat running/walking a road raceis a potentially hazardousactivity.I shouldnotenter unless I ammedically ableand properlytrained. I agree to abide by any decision ofa race officialrelativetomyabilitytosafelycompletethe event. I assumeall risksassociatedwith this eventincluding, but not limitedtofalls, contactwith other participants, theeffects of weather,trafficand conditionsof the road, allsuch risks beingknownand appreciated byme. Having read this waiver and knowing thesefacts and inconsideration of you acceptingmyentry, I, formyselfand anyone entitledto act onmybehalf;waive and releasethe St Stanislaus Youth, and allvolunteers associatedwiththis eventfromallclaims or liabilities ofanykind arising out ofmy participation inthisevent even though that liabilitymay ariseoutofnegligenceorcarelessnessonthe partof thepersons namedinthiswaiver.
Date:_
Signature:_