RACE COST All pre-registered participants will receive a T-shirt Pre Registration Must be registered by October 17, 2012 $25.00 After October 17, 2012 until Day of Registration $30.00 Schedule of Events 8:30 am: Registration Begins 9:30 am: Race Begins 11:00 am: Award Ceremony Awards will be presented to the top 3 male/female finishers in each age group 14-Under and over Donations We are looking for items to be used as raffle prizes and to be put in race participants gift bags. Any gift is greatly appreciated. Please contact Carrie Hosman St. Joseph Catholic School Mission Run 5k Fun Run/Walk Saturday October 27, 2012

RELEASE & WAIVER Please read, sign and date REGISTRATION FORM Mission Run – 5k Fun Run/Walk Saturday October 27, 2012 I know that running/walking is a potentially hazardous activity. I should not enter and run/walk unless I am medically able and properly trained. I also know that, although police protection might be provided, there could be traffic on the course route; therefore, I assume the risk of running/walking in traffic. I also assume any other risks associated with running/walking this event including, but not limited to, falls, contact with other participates, and the effects of weather and conditions of the road. I understand I am solely responsible for my own safety while traveling to and from or participating in this event. Knowing these facts and inconsideration of yours acceptance of my entry, I herby for myself, my heirs executors, administrators, or anyone else who might sue on my behalf covenant not to sue, and waive, release and discharge the sponsors to contributors to this event, any race official, volunteers, the city and police agencies, their representatives successors or assignees from any and all claims of liability for death, personal injury, or property damage of any kind or nature whatsoever arising out of, or in the course of my participation The release form and waiver extends all claims of every kind or nature whatsoever, foreseen and unforeseen, known and unknown. The undersigned further grants full permission to use any photographs, videotapes, motion pictures, recording, or any other record to the event for any purpose. Minors will be accepted with a parent’s signature ___________________________________________________ Signature Date Please R.S.V.P by October 17 th ___I will be able to attend as a ____ Runner ____ Walker __ I cannot but would like to make the following tax- deductible donation ______ ___ I cannot attend this year, but please keep me on the list for next year! Information: Name:__________________________________________ Address:_________________________________________ ________________________________________________ Phone#:________________________________________ Address:___________________________________ Age: ______ Male______ Female____ T-Shirt Size_________ (Small, Medium, Large, X- Large) Check payable to: St. Joseph Catholic School Mail to: 275 W North St, Manhattan, IL 60442