Win the 2016 Run in the Dark Storehouse Cup! 17 th Annual Run in the Dark Saturday, September 17, 2016 Bluestem Park at Alliance Town Center 9800 Hillwood Parkway Fort Worth, TX Community Storehouse is a local nonprofit relief organization “Dedicated to the education and well-being of low-income children in our community.” Help us serve the over 12,000 local children living at or below the poverty level by registering for the 17th Annual Run in the Dark on September 17, 2016 at Blue Stem Park, just north of Alliance Town Center. School Competition for the “Storehouse Cup” This will be our 9th year to award the “Storehouse Cup” to the school with the highest school participation. There will be 2 awards given; one for Elementary/Intermediate and one for Middle/High Schools. A school team consists of children and adults who register under their school’s name. The school with the highest number of registrants wins the “Storehouse Cup”. If your school has at least 50 runners, the Community Storehouse will award your school with a special gift of appreciation! Schedule Day of the Event 4:30 pm Late registration · 7:00 pm 1-Mile Fun Run and 5K to follow 9:00 pm Awards & Storehouse Cup presentation Please return completed form to P.O. Box 13 Keller, TX by Sept. 6 th or register online at before September 9th Storehouse Cup Participant Entry Form Only ONE runner name per form. You are welcome to make copies of this form. Name: ____________________________________________________________________ Age: __________________ School Name: ______________________________________________ Grade: _________________________________ Home Address: ___________________________________________ City: ________________________ Zip : __________ ___________________________________________________ Daytime Phone : ______________________________ T-shirt size : YS ____ YM ____ YL____ Adult SM ____ Adult MED ____ Adult LG ____ Adult XLG ____ 2XL____ CIRCLE your run(s) choice: 5K 1-Mile Fun Run Registration Fees □ Adult $24 □ Youth (18 & under) $20 □ Add Glow-In-The-Dark Bundle $5 x _____ (Qty.) = $ _____ (Includes Glasses, Necklace, and Bracelet) Online registration: Waiver Statement: I acknowledge that running/walking near automobiles and bicycles is extremely dangerous and that running/walking is an extreme test of a person’s physical and mental limits and there exists the possibility for death or serious injury. I certify that I am physically fit, have sufficiently trained for this event and have not been advised otherwise by a qualified medical person. I assume the risks of participation and assume full responsibility for injury, accident, or illness which may occur during the event or while I am on the premises of the event and I hereby release and hold harmless Community Storehouse, the City of Fort Worth, Hillwood Properties, volunteers, sponsors, promoters or the persons or entities associated with this event from any and all injury or damage whether it is caused by negligence of the sponsors, promoters, persons or entities associated with this event or otherwise. Further, I hereby grant full permission to any and all of the foregoing to use photo­graphs, videotapes, motion pictures, recordings or any of record of this event. Race officials reserve the right to refuse registration to anyone for any reason. Race will be held regardless of weather conditions. Registration is final, no refunds. T-shirt quantity is limited. Shirt and size are not guaranteed after September 9, Participant or Parent/Guardian (if under 18 yrs.) Signature: _________________________________________ Date: ________________ (Office Use only): Number Bib ____________ NEW this year… Glow-In- The-Dark- Bundles!!!