FREEDOM 5K November 11, 2017

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Late: after 10/28/17 $25 / $15. Race Day: 11/11/17 $25 / $15. TOTAL: ______. (NO REFUNDS). Office Use Only. Date rec'd _
FREEDOM 5K November 11, 2017 Registration Information 5K Race / 1 Mile Fun Run Early (by 10.28.17) $20.00 / $10.00 Late (after 10.28.17) $25.00 / $15.00 Race Day (11.11.17) $25.00 / $15.00 *T-shirt guaranteed with early registration ONLY!!

*Proceeds to benefit The Genesis House and HCHS XC Team

Race Day Itinerary 7:00 – 7:45am 8:00am 9:00am 9:30am

Mail or drop off entry forms to: Houston County High School Attn: Freedom 5K 920 Ga Hwy 96 Warner Robins, GA 31088 Make checks payable to: HCHS

Registration 5K Race Begins 1 Mile Fun Run Awards

*Race start & finish at Freedom Field

Awards Cont act Wen dy Chal

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Trophies awarded to – overall male & female finishers, and top 3 finishers in the following age groups: Male & Female 12 & under, 13-15, 16-18, 19-21, 22-25, 25-29, 30-39, 40-49, 50-59, 60-69, 70+ **All 1 Mile Fun Run finishers 12 & under will receive a medal at the finish line.

for more information: 478-988-6340 [email protected]

First Name: ____________________ Last Name: _______________________ Phone: _______________ Date of Birth: _____/_____/_____

Age as of 11/11/17 : __________ M ______ F ______

Address: __________________________________________ City: ________________________ State: _______ Zip Code: _______ Email: ___________________________________________________ Shirt Size (circle one): YS

YM

YL

S

M

L

XL

2XL

Emergency Contact: _____________________ Phone: ____________ Waiver and Release: In consideration of the foregoing, I myself, my heirs, executors, administrators, personal representatives, successors, and assigns, waive and release any and all rights, claims, and courses of action I have or may have against the event, its primary sponsors, and its affiliates, their agents, employees, officers, directors, sponsors, their representatives and successors, that may arise as a result of my participation in this event and any pre-and-post-race activities. As a parent/guardian I understand that I am responsible for knowing the UIL eligibility rules for any youth under my guardianship and take full responsibility for the entrant pertaining to said rules. I attests and verify that I have sufficiently trained for this event. Further, I hereby grant full permission to any and all foregoing to use my photos, motion pictures, recordings, and any other record of this event for any legitimate purpose, including commercial advertising.

Entrant Signature: ____________________________ Date: ________

ENTRY FEE (Please circle one) 5K Race / 1 Mile Fun Run Early: by 10/28/17 $20 / $10 Late: after 10/28/17 $25 / $15 Race Day: 11/11/17 $25 / $15 TOTAL: __________ (NO REFUNDS) Office Use Only Date rec’d __________ Bib # __________ Cash CC

Check # _______