CHILDREN’S SQUARE U.S.A.’S PLEASE READ THIS WAIVER/RELEASE BEFORE SIGNING REGISTRATION 5123 Leavenworth Omaha, NE 68106 Phone: (402) 556-6765 Fax: (402) 556-7862 www.childrenssquare.org 1. I know that participating in a race is a potentially hazardous activity, with both known and unknown risks. I should not participate in the 2015 “Run for the Young” unless I am medically capable for the walk/run. I assume all risks associated with participating in this event including, but not limited to: falls, contact with other participants, the effects of the weather, and the condition of the road. I understand and appreciate such risks. Having read this waiver and knowing these risks, and in consideration of your accepting my entry, I, for myself and anyone entitled on my behalf, waive and release Children’s Square U.S.A. and all race sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. 5K RUN/WALK FRIDAY, JUNE 5, 2015, 7 P.M. AT PEAK PERFORMANCE 519 N 78TH ST OMAHA, NE KEYSTONE TRAIL 2. I grant Children’s Square U.S.A. permission to reproduce, publish, circulate, copyright, or otherwise use any and all photographs and/or videotape of me and/or my family, taken at the 2015 “Run for the Young.” Special permission will be requested for photos, stories, videos, etc. that would include the sharing of personal or confidential information. SPECIAL THANKS TO OUR EVENT SPONSORS* __________________________________________ Signature of Participant __________________________________________ Name (Please Print) __________________________________________ Date McMahon The __________________________________________ Signature of Guardian (for children under 19 years of age) Family * of March 23, 2015 Race Day Friday, June 5, 2015 7 p.m. Race Location Peak Performance 519 N. 78th St. Omaha, NE REGISTRATION FORM DATE _______________ NAME ___________________________________ ADDRESS ________________________________ __________________________________________ PHONE ___________________________________ EMAIL ___________________________________ GENDER _____ male _____ female RACE DESCRIPTION: 5K Flat and Fast throughout the trail. Walkers are welcome to start behind the runners. The race will start at The Keystone Trail outside of Peak Performance. RUN DIVISIONS: “Run for the Young” is an excellent way to show support and appreciation for our foster families. Proceeds fund summer camps for children in our foster care homes. “RUN FOR THE YOUNG” Providing family foster care and support services in the Omaha, Nebraska community since 1991, Children’s Square U.S.A.’s foster care program provides positive family environments for Nebraska children needing out of home care. Our families enriched the lives of nearly 120 children in 2015. Fortytwo children are currently in care with 38 foster families. You, too, can make a difference by becoming a foster parent, joining us for the “Run For The Young” or making a gift today to help fund summer camps. • Age 19 and under • Ages 20 to 29 • Ages 30-39 • Ages 40 to 49 • Ages 50-59 • Ages 60-69 • Ages 70 and over For more information about Run for the Young or foster parenting opportunities, please contact Mary Uhlig at (402) 556-6765. DATE OF BIRTH __________________________ CIRCLE SIZE OF T-SHIRT BELOW: S ADULT SIZES: M L XL XXL YOUTH SIZES: M L PRE-REGISTRATION Pre-registration application and payment must be received or postmarked by Wednesday, June 3, 2015. Those who pre-register will receive a “Run for the Young” t-shirt. Method of Payment: Check* Cash Online *make checks payable to Children’s Square U.S.A. Please mail or hand deliver your registration and $15 fee to: Children’s Square U.S.A. 5123 Leavenworth St Omaha, NE 68106 Visit www.childrenssquare.org to register online. Registration on Race Day You may register the day of the race for an additional $5. The $20 entry fee may be paid by cash or by check made payable to Children’s Square U.S.A. Registration will begin at 5:30 p.m. Remaining t-shirts will be distributed while quantities last.
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