Rock the Docks '09
"Summit County's
Summer Tradition"
5K RaceSaturday, July 19, 2008 8:00 A.M.
Springfield High School
5K AWARDS: O/A Male/Female; O/A Master Male/Female; Top 3 in age divisions starting at 14 & under
Pre-Registration: Received now through July 1st: $15.00 and will be guaranteed a shirt!
Late Registration: Received July 2nd to July 15th: $20.00
Make check payable to: Springfield Lakemore Festival Committee and mail it, with this form to:
Lakemore Police Department, Attn: Gwen, PO Box 193, Lakemore, Ohio 44250
DEADLINE: All Registrations must be RECEIVED by June 15
On-site Registration and Race Packet Pick Up will be at 1400 Main Street, Lakemore, OH 44250
on July 10th from 6-9pm and July 14th from 6-9pm.
LACK OF REGISTRATION AND/OR PACKET PICK UP AT THE ABOVE TIMES WILL
CONSTITUTE FORFEIT OF PARTICIPATION IN EVENT.
I KNOW THAT RUNNING A RACE 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 DECISIONS OF THE RACE OFFICIAL RELATIVE TO MY ABILITY TO SAFELY COMPLETE THE RUN. I ASSUME ALL RISKS ASSOCIATED WITH RUNNING THIS EVENT INCLUDING, BUT NOT LIMITED TO: FALLS, CONTACT WIH OTHER PARTICIPANTS, THE EFFECTS OF THE WEATHER, INCLUDING HIGH HEAT AND/OR HUMIDITY, TRAFFIC AND THE CONDITIONS OF THE ROAD, ALL SUCH RISKS BEING KNOWN AND APPRECIATED BY ME. I UNDERSTAND THAT BICYCLES, SKATEBOARDS, BABY JOGGERS, ROLLER SKATES OR INLINE SKATES, ANIMALS AND HEADSETS ARE NOT ALLOWED IN THE RACE AND I WILL ABIDE BY THIS GUIDELINE. I GRANT PERMISSION TO ALL OF THE FOREGOING TO USE ANY PHOTOGRAPHS, MOTION PICTURES, RECORDINGS, OR ANY OTHER RECORD OF THIS EVENT FOR ANY LEGITIMATE PURPOSE. HAVING READ THIS WAIVER AND KNOWING THESE FACTS AND IN CONSIDERATION OF YOUR ACCEPTING MY ENTRY, I, FOR MYSELF, AND ANYONE ENTITILED TO ACT ON MY BEHALF, WAIVE AND RELEASE SPRINGFIELD TOWNSHIP AND THE VILLAGE OF LAKEMORE, ALL SPONSORS, THEIR REPRESENTATIVES AND SUCCESSORS, FROM ALL CLAIMS OR LIABILITIES OF ANY KIND ARISING OUT OF MY PARTICIPATION IN THIS EVENT, EVEN THOUGH THAT LIABILITY MAY ARISE OUT OF NEGLIGENCE OR CARELESSNESS ON THE PART OF THE
PERSONS NAMED IN THIS WAIVER.
Print out page and return to:
Lakemore Police Department, Attn: Gwen, PO Box 193, Lakemore, Ohio 44250
5K Race Registration Form
Lakemore Police Department, Attn: Gwen, PO Box 193, Lakemore, Ohio 44250
5K Race Registration Form
Name: ___________________________________________________________
Address: _________________________________________________________
State: ________ Zip Code: __________
Gender (please circle): Male / Female Birth Date: ____/___/___ Age on Race Day: _______
T-shirt Size (please circle): Small Medium Large Extra Large
Email address: ______________________________________
Telephone Number: ( )____________________________
Running Club Affiliation: _______________________________
Signature: __________________________________________
Parent’s Name: ______________________________________
Parent’s Signature: ___________________________________
(PARENT’S NAME AND SIGNATURE IS REQUIRED IF UNDER 18 YEARS OLD)
