Please drop off or mail registration along with payment to:

Summit Park District, 5700 S. Archer Rd., Summit, I L 60501 OR register online at event search at
https://www.signmeup.com
Any questions feel free to contact Park District 708-496-1012 or www.summitparks.org.


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Registration Form
Waiver of Liability: I agree that by participating in the Warehouse Project and Gallery Running Back to School 5k Run/Walk, I
do so at my own risk. I assume all risk of injury, illness, damage or loss to me or my property that may result, including without
limitation, any loss or theft of personal property. I consent to medical treatment in the event of injury, accident and/or illness
during Running Back to School 5K Run/Walk. I n exchange for accepting my entry fee, I agree to be legally bound, for myself,
my heirs, next of kin, executors, and administrators, and voluntarily assume all risks of accident or injury and release and forever
discharge, indemnify and hold harmless The Warehouse Project & Gallery and 5K Run/Walk, The Summit Park District,
employees, members, representatives, agents, volunteers, and/or sponsors (Released Parties) from any and all liability for
personal injury or property damage of any kind sustained during the Running Back to School 5K Run/Walk whether such
personal injury or property damage is caused directly or indirectly by the Released Parties. I have full knowledge of the risks
involved and attest that I am physically fit and sufficiently trained to participate in the 5K Run/Walk. Additionally, by signing I
agree that my picture can be used for promotional purposes in print and online material.

PLEASE PRINT INFORMATI ON 5K RUN/WALK KIDS 1 MILE RUN
Name _______________________________________ DOB ____________ Age ______ Male Female

Address_____________________________________ City____________________ State _________ Zip _________

Phone: _____________________________________ Email _____________________________________________

T-Shirt Adult Size: S M L XL XXL Youth Size: YS YM YL
_______________________________________ _______________ _____________________________
Signature Date If applicant is under 18 years of age,

When: Saturday, August 9
TH
2014
Where: Summit Park
Who: Everyone
Cost: $15 early bird
$20 day of Registration
$10 Kids 1 Mile
Registration: 8:00 a.m.
Race Time: 9:00 a.m.