Inaugural MOHF 5K

LaSalle Springs Middle School 3300 Highway 109, Wildwood, MO 63038

Saturday, October 6, 2012

8:30 am: Race Check In 9:00 am: 1 Mile Fun Run Starts; 5K Follows

To secure your spot and dry fit shirt, please submit your registration with payment prior to September 14, 2012. Walk up entries accepted, but reservations are strongly encouraged.

Please come and support the Mighty Oakes Heart Foundation and enjoy the fall scenery along the trails of LaSalle Springs. This race is a charitable event, and all proceeds will benefit the MOHF as it continues to provide financial support to families coping with congenital heart defects. To participate in this very special event, please fill out the form below. Payment can be made by cash or check. Please make checks payable to: Mighty Oakes Heart Foundation and submit to: MOHF 5K Race, c/o Adam & Suzanne Gabris, 2213 Glencoe Summit Court, Wildwood, MO 63011.
Course Description: The course will be an out-and-back route with the start/finish at LaSalle Springs Middle School. Participants will run along portions of the Al Foster trail and new trail extension. Adult Dry Fit Shirt Youth Dry Fit Shirt Male/ Female/ Name of Participant Men/Women Cut Unisex Age Age
S/M/L/XL/2XL S/M/L/XL

Race Options Adults- 5K Run/Walk Kids- 1 Mile Fun Run Additional Dry Fit Shirts @ $20 each
Additional Tax Deductible Donation

Registration Fee
includes 1 dry fit shirt per entry

# of Entries

Total Fees

$30.00 $20.00
Male Female S M L XL 2XL (circle) Youth S M L XL (circle)

TOTAL ENCLOSED:

For questions or to become a corporate sponsor, please email MOHF5Krace@gmail.com. Name: ________________________________________________________________________________________________________ Address: ______________________________________________________________________________________________________ Phone: ________________________________________ Email: _____________________________________________________
Waiver of Liability: IN CONSIDERATION OF ACCEPTING THIS ENTRY, I THE UNDERSIGNED, INTENDING TO BE LEGALLY BOUND, HEREBY FOR
MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, WAIVE AND RELEASE ANY AND ALL CLAIMS FOR DAMAGES, DEMANDS, ACTIONS, AND CAUSES OF ACTIONS AGAINST THE ROCKWOOD SCHOOL DISTRICT, THE CITY OF WILDWOOD, LASALLE SPRINGS, MOHF, THEIR AFFILIATES, SUBSIDIARIES, OFFICIALS, REPRESENTATIVES, EMPLOYEES, SUCCESSORS AND ASSIGNS FOR AND ALL INJURIES SUFFERED BY ME IN THIS EVENT. I ATTEST AND VERIFY THAT I AM PHYSICALLY FIT AND HAVE SUFFICIENTLY TRAINED FOR THE COMPETITION OF THIS RUN. MY SIGNATURE ON THIS FORM FURTHER GIVES PERMISSION TO THE EVENT HOLDERS TO TAKE PHOTOGRAPHS/VIDEO OF ME, IF APPLICABLE AT THIS EVENT AND TO USE THESE IMAGES FOR ANY LEGITIMATE PURPOSE FOR PROMOTION OF THIS EVENT. PAYMENT FOR THIS EVENT IS NON-REFUNDABLE. TO MAINTAIN THE SAFETY OF OUR RUNNERS, WE RESERVE THE RIGHT TO CANCEL THE RACE DUE TO INCLEMENT WEATHER.

SIGNATURE (Parent or Guardian of Runner if under 18):________________________________Date:_________________