Road Race - James Valley Christian School
JAMES VALLEY ROAD RACE July 23, 2016 ~~ 5k/10k/2 mile walk Registration/Packet Pick-Up 7:00-7:30AM Race 8:00 AM Fundraiser road race for the James Valley Christian School cross country team (organized by Huron First Assembly of God). Complete the bottom of this form and return to: Huron First Assembly of God (Road Race) 920 Lincoln Ave SW Huron SD 57350 Make checks payable to Huron First Assembly of God Contact Tom Brantner for more information (605) 354-1947 or [email protected] Race begins and ends at JVCS (1550 Dakota Ave N). Early registrations must be received no later than 07/15/2016 at 9:00 AM. T-shirts guaranteed with early registration ONLY!!! Online registration available at www.allsportcentral.com. Awards for M/F overall Top 3 in 5k/10k and in each age category: (M: 12 & under) (M: 12-18) (M: 18-29) (M: 30-39) (M: 40-49) (M: 50-59) (M: 60+) (F: 12 & under) (F: 12-18) (F: 18-29) (F: 30-39) (F: 40-49) (F: 50-59) (F: 60+)
—————————————————————————————————————— First Name _________________ Last Name ____________________________ Phone _________________ Address _________________________________________________________________________________ City ___________________ State ________ Zip code _____________ Email ___________________________________________________________________________________ Birthday ____/____/______ Race (circle one): Entry Fee (circle one):
5k
10k
Age on race day _________
2 mile walk
Early Registration $25 (before 07/15/2016)
M_____ F_____
Shirt size (circle one):
S
M
L
XL
Late Registration $30 (after 07/15/2016)
Emergency Contact ___________________________________________ Phone ______________________ Waiver & Release: I know that running a road race is potentially hazardous and that I should not enter and run unless I am medically able and properly trained. I assume all risks associated with participating in this event. Having read this waiver and knowing these facts and in consideration of accepting my entry, I and anyone entitled to act on my behalf, waive and release James Valley Christian School, all race volunteers, sponsors, their representatives, employees and successors from any claims and liability of any kind arising out of my participation in this event or carelessness of the persons named in the waiver. Further, I grant to all the foregoing the right to use any photographs, motion pictures, recordings or any other record of this event for legitimate purposes.
Entrant Signature ______________________________________________ Date ____/____/______ (Parent/Guardian if under 18)
—————————————————————————————————————— First Name _________________ Last Name ____________________________ Phone _________________ Address _________________________________________________________________________________ City ___________________ State ________ Zip code _____________ Email ___________________________________________________________________________________ Birthday ____/____/______ Race (circle one): Entry Fee (circle one):
5k
10k
Age on race day _________
2 mile walk
Early Registration $25 (before 07/15/2016)
M_____ F_____
Shirt size (circle one):
S
M
L
XL
Late Registration $30 (after 07/15/2016)
Emergency Contact ___________________________________________ Phone ______________________ Waiver & Release: I know that running a road race is potentially hazardous and that I should not enter and run unless I am medically able and properly trained. I assume all risks associated with participating in this event. Having read this waiver and knowing these facts and in consideration of accepting my entry, I and anyone entitled to act on my behalf, waive and release James Valley Christian School, all race volunteers, sponsors, their representatives, employees and successors from any claims and liability of any kind arising out of my participation in this event or carelessness of the persons named in the waiver. Further, I grant to all the foregoing the right to use any photographs, motion pictures, recordings or any other record of this event for legitimate purposes.
Entrant Signature ______________________________________________ Date ____/____/______ (Parent/Guardian if under 18)
