REGISTRATION INFORMATION Please send your registration form and fees by June 7, 2013 to: Case Middle School Fitness

& Nutrition Club 1237 Washington Street

The proceeds for this 5th annual event will benefit the Case Fitness & Nutrition Club and the American Brain Tumor Association!

“Fitting In” Fitness & Nutrition Club Run/Walk Registration Form

Name:________________________________

Address: _____________________________

_____________________________

Phone: _______________________________

Age on Race Day: _____ DOB:___________

Email address: ________________________ Gender: Male Female

Watertown, NY 13601

5K Run/Walk ____$20 by Friday, June 7, 2013
(please circle)

____$25 after pre-registration

Registration forms can be printed from our school website:

_____Free 1 mile Fun Run/Walk T-shirt $10

www.watertowncsd.org
Pre-registration Packet Pickup will be available on Friday, June 14th at the Case Middle School Counseling Office from 12:30pm to 4:00 pm.

The 5K Run/Walk course will start at the track, go down to Green St. to School St., down the driveway in front of Case and Watertown HS, around and up to the upper parking lot at Wiley School, through the nature trails up behind Wiley, and finish down at the track. The 5K Run/Walk will begin at 9:30 am. The 1 mile Fun Run/Walk will be 4 laps around the track and begins at 9:00 am. Awards presentation at 10:30 am.

Pre-registration forms must be received by June 7th to be guaranteed a T-shirt!!! Adult T-shirt size:

S

M

L

XL

Top male/female in each age bracket for th 5K Run will receive a race medal. (Please
Check)

___ 14 and under ___ 15-25 ___ 36-45 ___ 46-55

___ 26-35 ___ 56 +

Only cash and checks will be accepted. Please make any checks out to: Case Fitness & Nutrition Club

Race Day packet pickup and registration will be from 7:30 am to 8:30 am at the rear lobby area of Case Middle School.

There will be a 50/50 raffle at the track. Tickets may be purchased the day of the race.

Pre-registration must be received by June 7th!

Please sign and date WAIVER on back side Thank you!

WAIVER I know that participating in this run/walk is potentially hazardous. I should not enter unless I am medically able and properly trained. I also assume any and all risks associated with this event including but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, and the condition of the roads and traffic, all such risks being known and appreciated by me.

Case Middle School “Fitting In” Fitness & Nutrition Club

Knowing these facts, and in consideration of your accepting entry, I hereby, for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, covenant not to sue, and waive, release and discharge The Watertown City School District, sponsors, the City of Watertown, the State of New York, and/or any agents authorized by them for any purpose.

Thank you to our SPONSORS and to all of the donors who are committed to the health and wellness of our students!!!

June 15, 2013 9:00 am

This release and waiver extends to all claims of every kind or nature, whatsoever, foreseen or unforeseen, known or unknown. Applications for minors are accepted only with a parent/guardian signature.

___________________________________________ Name of Participant

“Fitting In” Fitness & Nutrition Club Case Middle School 1237 Washington Street Watertown, NY13601
Contact Information: Sheryl Foan Case Middle School (315)785-3880

______________________________________ Signature of Participant

______________________________________

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