Hustle 4-Health 5K Run/Walk
151 E. Briarcliff Rd., Bolingbrook, IL 60440
April 12, 2014 8:00AM
Registration
First Name: _________________________
Last Name: _________________________
Address : __________________________City: ______________________________
State: _____________________________Zip: _______________________________
Home Phone: _______________________
Cell Phone: _________________________
Email: _____________________________
Gender: Male Female
Shirt Size: Small Medium
Large X-Large
(Shirt sizes will be based on regular men sizes.)
Date of Birth: _________________
Age on Race Day: ________
Payment: Make $25.00 check payable to Bolingbrook Christian Health Clinic and mail to the address below by April 2nd, 2014:
Hustle 4Health 5k ATTN: Maria Schilder 317 Janes Ave Bolingbrook, IL 60440
A Special thanks to our Sponsor
BOLINGBROOKCHRISTIAN
HEALTH CENTER
BOLINGBROOKCHRISTIAN
HEALTH CENTER
BOLINGBROOKCHRISTIAN
HEALTH CENTER
BOLINGBROOKCHRISTIAN
HEALTH CENTER
BOLINGBROOKCHRISTIAN
HEALTH CENTER
BOLINGBROOKCHRISTIAN
HEALTH CENTER
BOLINGBROOKCHRISTIAN
HEALTH CENTER
BOLINGBROOKCHRISTIAN
HEALTH CENTER
The 5K Run / WalkApril 12th, 2014
8:00 AM Race Starts
9:15 AM Award Ceremony
New Song Church Front Parking Lot
151 E Briarcliff Rd, Bolingbrook, IL 60440
Course descriptionLine up begins at 7:30 a.m. in the front parking lot of New Song Church in Bolingbrook. The first 2 miles are through the quiet neighborhood. This portion of the race is mainly flat with a little incline at the beginning. The last mile involves running on a park district trail that is paved and hilly.
Award CategoriesOverall male and female winner (not eligible for age division awards)
• 14 & under• 15-19• 20-29• 30-39• 40-49• 50-59• 60 and above
Registration• Online pre-registration, $25 plus
surcharge, closes on 4/9/2014 at 9 AM
• Registration by Mail with a $25 check payment, must be received by 4/11/2014
• On-site Registration, $30 cash or check only, Wed 4/9 4-7 PM; Fri 4/11 4-7 PM, and Sat 4/12 7-7:45 AM
• No refunds on fees due to inclement weather cancellations
Shirt SizesPaid registrants by March 15, 2014 will receive a long sleeve tech wicking running shirt; after that day, while supplies last. Shirt sizes will be based on regular men sizes of the following: S. M, L, XL.
Packet Pick-Up Dates• Wednesday, April 9th 4-7 PM 151
E. Briarcliff, Bolingbrook, IL West door
• Friday, April 10th 4-7 PM 151 E. Briarcliff, Bolingbrook, IL West door
• Day of the race, 7-7:45 AM 151 E. Briarcliff, Bolingbrook, front parking lot
WAIVER
I hereby for myself, my heirs, executors and administration, waive, release and discharge any and all rights and claims for damages, however minor or serious, that I/my child may sustain as a result of participation in any and all activities connected with the Hustle 4-Health 5k Run/Walk against the Bolingbrook Christian Health Center, New Song Evangelical Free Church, 4-H 4 Joy club of Bolingbrook, Will County 4-H Extension, or the Village of Bolingbrook or any sponsors of the event. I assume all risks associated with running/walking in this event, including but not limited to: falls, contact with other participants, the effects of the weather including cold or heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I attest and verify that I have full knowledge of the risks involved and that I/my child am physically fit and sufficiently trained to participate in this running/walking event. I hereby grant my consent to any of the above named parties and their authorized agents to use my/my child’s name and any photographs, video tapes or recordings of my participation in this event for any lawful purposes without compensation to me/my child or my behalf. TERMS • The following are not allowed in the race: animals, bicycles, skateboards, roller skates or roller blades• Baby strollers and baby joggers are allowed in the back with the walkers• Head phones, iPods, mp3 players and similar device are strongly discouraged. Such devices may impair a person’s ability tohear, use proper judgment or detect potential hazards on the course• Participants must be able to finish the course within 1 hour and 15 min
Please sign at the X below if you have read and agree to the waiver and terms:
X __________________________________________________
Date: __________________________
How did you hear about the race?_________________________
____________________________________________________
*PARTICIPANTS UNDER 18 YEARS OLD:Parent/Guardian’s Name:______________________________________________
Date: _____________
Parent/Guardian’s Signature: ____________________________