Kosciusko Runners' Association

Finish-line Management and Expert Coaching

Home
About Us
Contact Us
Upcoming Events
REGISTRATION Forms
RACE RESULTS
OLD Race Results
 Copy and Paste any registration form to a Word Doc. and Print! 
 ++++++++++++++++++++++++++++++++++++++++++++++
         
++++++++++++++++++++++++++++++++++++++++++++++++++++++++
 
 

 

THE

SOLID ROCK

5K RUN & WALK

 

April 15, 2012 ~ 2:00 p.m.

Proceeds benefit Youth Mission Trip Fund

 

NEW

ELECTRONIC

TIMING & NEW

AGE DIVISIONS!

 

 

Race day registration:           12:30 - 1:30 p.m. at the South Whitley United Methodist Church,

South Whitley, IN (near intersection of State Roads 5 & 14).

 

Mail pre-registration to:       SWUMC Youth

c/o Amy Bechtold, 8935 W – 400 S, South Whitley, IN  46787

 

Entry fees:                             $15.00 pre-registration* - $20.00 day of race

 

Contact information:            asher3@embarqmail.com;   kmize@embarqmail.com;

                                                or Amy Bechtold 260/723-5033

 

NEW AGE GROUP DIVISIONS:  Elementary, Middle School (6th, 7th, 8th), High School,

19-29, 30-39, 40-49, 50-59, 60+

 

Come and enjoy fun, fellowship, and fitness ~ no matter what your pace!

Baby strollers welcome.  No dogs please.

Refreshments provided post-race.  Childcare is available. 

Name of participant:

                                                                                    (print) Male / Female   Age/Div.:                              

 

(Address)                                                                                                                                                                              

 

(E-mail Address)                                                                                     (Phone Number)                                                              

 

T shirt size: ____S    ____M    _____L    ____XL  ____XXL (additional $1.00 fee for XXL)

*T-Shirts available for all who pre-register by April 9, 2012.

                                                                       

PLEASE READ AND SIGN RELEASE: I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in races, including, but not limited to: falls, contact with other participants, the effect of the weather, including high heat and/or humidity or lightning, the conditions of the road and traffic on the course, all risks being known and appreciated by me. Having read this waiver and knowing the facts and in consideration of your acceptance of my entry in the race, I, for myself and anyone entitled to act on my behalf, waive and release the directors of this race, the South Whitley United Methodist Church, all sponsors, their representatives and successors, from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in the waiver. I grant permission to all of the foregoing to any photographs, motion pictures, recording or any other record for legitimate purpose.

 

___________________________________________                                            _______________________

Signature of Participant or guardian                                                                                Date