Saturday, May 17^th, 2014

At Boys & Girls Club of Marino County, 565 Oak Street Marion, OH 433302

Benefits Boys & Girls Club of Marion County

Race Day Registration Opens at 7:30am

Kids Fun Run Starts at 8:30am- Adult 5k starts at 9:00am

Awards for category and overall winners

Cost:

Kids Fun Run (11 years & under)- FREE

Adult 5k- $25 with Pre-registration or $30 on Race Day

(T-shirt guaranteed if registered by May 1^st, 2014)

Pre- register online or at the Club (565 Oak Street Marion, OH 43302)

Checks made payable to: Boys & Girls Club of Marion County)

United Way of Marion County Agency Partner

I know that running and road racing are potentially hazardous activities. I will not enter this race unless I am medically able and properly trained. I assume all risks associated with this event, including but not limited to, falls, contact with other participants, the effects of the weather including low temperature and/or precipitation, traffic, and the condition of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, in consideration of accepting this entry, I, the undersigned, intending to be legally bound, for myself, my heirs, executors, and administrators, waive and release any and all claims for damages I may have against the Boys & Girls Club of Marion County from any and all liabilities, claims, demands, and causes of action whatsoever arising directly or indirectly from my participation in this event. I also release my rights to any photos, videos, images, etc. taken of me during this event.

Name: ________________________________________           Age:____________   Gender: F   M

Address: _____________________________________    Date of Birth: ________________

   _____________________________________   Circle one:   Kids Fun Run 5K

Phone: ______________________________________   T-shirt Size: Sm Med LG XLG

Signature: ____________________________________ Please Print Legibly