Shalom Christian Academy

126 Social Island Road

Chambersburg, PA 17202
To: __________________________
__________________________
__________________________

SCA 5K
Run/ Walk
& Fun Walk

Saturday
May 2, 2015

SCA 5k & Fun Walk

The SCA 5k is a part of the

annual Dutchfest. The race starts
and ends on Shaloms campus.
The 5k course is out and back,
going over rolling country roads
and crossing the picturesque
Conococheague Creek.

For children pre-k through 2nd

grade. Approximately half a mile
walk with activity stations along
the way.
For more information:
shalomca.com/dutchfest
or call 717-375-2223

Fun Walk
FRE

if re -SHIR
befo gistered T
re Ap
ril 22
nd

ET

Registration at 7:30am
Race Begins at 8:30am

Saturday, May 2, 2015

All proceeds benefit
Shalom Christian Academy

Divisions

Under 18
19-39
40+

$50 prize for male and

female winners of each
division.

Sponsered by John Reinert

After 4/22/15 - $25

After 4/22/15 - $15

Shalom Student/ Alumni: Y / N - $5 discount

Make checks payable to Shalom Christian Academy

5k Run/Walk- by 4/22/15 - $20

Fun Walk- by 4/22/15 - $10

Participant Signature:__________________________________

(parent or guardian signature if under 18)

Cost:

Shirt Size: Adult S, M, L, XL, XXL

Youth S, M, L

Release and Consent Form: In consideration of the acceptance of my entry/

my childs entry, I for myself of my child, our executors, administrators
and assignees... do hereby release and discharge the organizer of this race
and all other sponsors and organizers of all claims and damages, actions
whatsoever in any manner arising out of my/ my childs participation in
said athletic event. I attest and verify that I have full knowledge of the risks
involved in this event and I am/ my child is physically fit and sufficiently
trained to participate in this event. Further, I hereby grant full permission
to any/ all of the foregoing to use my/ my childs name, photographs, videotapes, motion pictures, recordings or any other record of the event for any
legitimate purpose without compensation of remunerations.

Please mail registration forms to:

Shalom Christian Academy
126 Social Island Road
Chambersburg, PA 17202
Attn: SCA5K

Name:_____________________________ 5k Run:_____ 5k Walk:_____ Fun Walk:_____ Age:______

Gender: M / F Email:_____________________________ Phone Number:__________________
Address: ___________________________ City:_____________________ State:______ Zip: __________

Fourth Annual