Before printing this form, please TYPE in all required information, it will print with the form. Enclose your payment and mail to: Run for Hospice 34 Denishire Drive Rochester, NY 14624
(for race use only)
Last Name
First Name
MI
Address
City
State
Zip
Age on Race Day
Birthdate:
Phone # - -
Email:
Registration fees for the 5K & 10 Mile Road Races & the 5K Fitness Walk: $17.00 postmarked by October 4, 2008 $20.00 postmarked after October 4, 2008 $25.00 for all race day registrants (October 18, 2008)
Registration fee for the Children's Fun Run $5.00 pre & post entries (does not include a T-shirt)
I have enclosed my registration fee of $.
I have enclosed my sponsor form and donations totaling
$. (raise $60 and your race registration fee will be waived)
I would like to make an additional donation to Visiting Nurse Hospice $
WAIVER I know that running a road 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 the decision of the race director relative to my ability to safely compete in this run. I assume all risks associated with running in this event including but not limited to: falls, contact with other runners, the effects of weather including heat and/or humidity, traffic and conditions of the road, all such risks being known and appreciated by me. I also know that although the Greece Police Department will be assisting with this race, there will be traffic on the course route. I agree to assume the risk of running in traffic. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone to act on my behalf, waive and release the Run for Hospice, Pete Van Peursem and his family, all volunteers and sponsors, First Bible Baptist Church, the Town of Greece, Visiting Nurse Hospice, their representatives & successors from all claims and liabilities of any kind out of my participation in this event before, during or after.
