Winthrop Elementary STEM 1st Annual 5K Run
Tuesday, April 09, 2013

 

Winthrop STEM Magnet Elementary School

 1st Annual 5K Run or Walk

 5K Walk/Run on JUNE 8, 2013

 

First Name: _______________ Last Name: _________________  

Address: _____________________________________________

City: ________________________ State: _______ Zip: _________

Telephone: (_____)_____________Male: ______ Female: ______

Age on Race Day: ______

T-Shirt: Adult Size: Small ____ Medium ____ Large ____ XL ____

             Child Size: Small_____ Medium _____ Large_____

 *Awards given to top 3 male and female finishers in six different age groups*

Date:    June 8, 2013

Registration: 9:00 a.m. at: Winthrop STEM Magnet Elementary School

Start Time:    10:00 a.m. at: Winthrop STEM Magnet Elementary School

Waiver: I know that running a road raced is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event including but not limited to falls, contacts with other participants, the effects of weather, including high heat and or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Winthrop STEM Magnet Elementary School/Winthrop Magnet PTO and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I grant my permission to all the forgoing to use any photographs, motion pictures, recording or any other record of this event for any legitimate purpose. 

Signature: __________________________  Date: _______________

If under 18:

Parent/guardian signature: _____________________ Date: _________

 Entry forms can be mailed to:

 Winthrop STEM Magnet Elementary School

74 Grove Street

 New London, CT 06320

 Fee: $20 [pre-registration] - $25 [race day registration]

 Make checks payable to: Winthrop Magnet PTO

 Or pay on-line at:  http://www.active.com/directory/Running/5K/CT/New-London/

FIRST 200 PARTICIPANTS GET A SHIRT!!!