Spring Chicken 5K - Family YMCA of Northwest Illinois

YMCA Spring Chicken 5K
Race Date: Sat., May 2nd, 2015
Race Starts at 9:00 a.m.
A Race to Benefit the YMCA’s Strong Kids Campaign
2015 5K Fun Run/Walk Registration
In-Person or by Mail or online:
Family YMCA of Northwest Illinois
2998 W. Pearl City Rd., Freeport, IL 61032
Race Safety
Gender (Please Circle): Male Female
Mailing Address: ________________________________
City:______________________State:_____ Zip: _______
Phone: ______________________
Bicycles, roller skates, rollerblades and all other wheeled
vehicles (except wheelchairs and racing strollers) are
prohibited from the race in order to ensure the safety of
runners. We also consider the use of headphones in
running events to be a safety hazard and caution you to
be careful when using them during the race.
$20 postmarked by 5/1/2015
Pre-Race Registration ends 5/1/15 at 9:00pm
Race Day Registration from 7am to 8:30 am for $25
T-Shirt Size (Check One):
____ Adult-S
____ Adult-M
____ Adult-L
____ Adult-XL
____ Adult-XXL (add $2)
Total Cost:
$____________ 5K Run ($20/$25)
$____________ T-Shirt Cost (If XXL is Ordered)
$____________ Tax Deductible Donation to YMCA
$____________ TOTAL ENCLOSED
Race Waiver
I hereby acknowledge that running/walking a road race is a potentially hazardous activity, and that I am medically able and properly
trained to enter and run/walk. I agree to abide by any decision of a
race official relative to my ability to safely complete the run/walk. I
assume all risks associated with running/walking in the race, including, but not limited to, falls, contact with other participants,
the effects of the weather, high heat and/or humidity, low temperature, traffic and conditions of the road. In consideration of your
accepting my entry, I, for myself and anyone entitled to act on my
behalf or on behalf of my estate, hereby waive and release all
sponsors, event producers, event volunteers, race directors and
staff, and all states, cities, counties or localities from all claims or
liabilities of any kind related to or arising out of my participating
in the race even though the liability may arise out of personal negligence or carelessness. I also grant permission for the use of any
photographs, motion pictures, recordings or any other record of my
participation in this event for any legitimate purpose and understand I will not be compensated for the use of such. I understand
that if the race is cancelled because of circumstances beyond the
control of the race committee and sponsors, including, but not
limited to, unsafe weather conditions or governmental ban, my
entry fee will not be refunded.
Signature of Runner or Walker:
Signature of Guardian (if under 18 years of age):