2011 Thumbs Up 5K Walk/Run Registration Form

Saturday, August 13, in Winton Woods at Kestrel Point, Cincinnati, OH, 9am - 1:30pm

5K Walk/Run begins at 10:30AM (Registration at 9:00AM). The course will Start and Finish at Kestrel Point and loop around Winton Lake and to Hawk Knoll and back. Dont forget your vehicle park permit. Pre-Registration $20.00 Pre-Registration (add $10 for a t-shirt) $5.00 Kids (8 and under) Pre-Registration no shirt Registration on Event Day $25.00 Registration on event day without t-shirt $35.00 Registration on event day (includes t-shirt while supplies last) $10.00 Kids (8 and under) Registration on event day no shirt Make checks payable to: Messiah Lutheran Church (Linnabary Walk/Run in memo section) Mail form and payment to: Messiah Lutheran Church, 10416 Bossi Lane, Cincinnati, OH, 45218

Name:________________________________________________________ Date _____________________ Address: ________________________________________________________________________________ Daytime Phone: ________________________Email: ___________________________________________ Gender: ___ M ___ F Age on race day: ____________ Run________ Walk________ T-shirt Size: (circle) S M L XL Any special medical conditions: _____________________________ ________________________________________________________________________________________ Emergency Contact _______________________________________ Phone _________________________ Signature of Parent/Guardian if under 18_____________________________________________________
Waiver On behalf of myself, my heirs, executors, estate, successors, and assigns, I hereby release Messiah Lutheran Church, the City of Cincinnati, Cincinnati Park Board, club and race sponsors, affiliates, managers, coordinating groups, volunteers and all other individuals, groups, and entities associated with this event, as well as their affiliates, agents, employers, directors, officers, and members, from all claims which may arise from or as a result of my participation in Help Jennifer Linnabary Thumbs Up Benefit Walk/Run. In consideration of the acceptance of my entry and my participation in this event, I understand and agree that I give this release to the full extent permitted. I certify that I am physically fit and able to participate in this event, and agree to assume all risks of my participation. I understand and agree that my name and picture or photograph of my participation in this event may be used for results and publicity purposes. I HAVE NOTED ANY SPECIAL MEDICAL CONDITIONS ON THIS FORM. Please Sign Below Your signature will signify your understanding, acceptance, and authorization to accept the conditions of this legal document, including the following statements: I have read, have understood, and do accept the agreement above. I understand that this is a legal document with effects that I approve and authorize.

Signature:_________________________________________________________________________________