Event Information
Schedule of Events
CCMH Foundation Superhero 5K Run/Walk and Children’s Fun Run
Schedule of Events for Saturday, May 6, 2017
7:30 a.m. Registration and Packet pick up
8:30 a.m. Children’s Fun Run
9 a.m. 5k Run/Walk Starts and Children’s Activities start inside the hospital
Costumes Participants are encouraged to dress up with the superhero theme.
****RAIN OR SHINE****
Awards
Awards Medals will be given to all the finishers of the race. Top male and fe-male racers will be recognized in each age category including: 12 and under, 13-19, 20-29, 30-39, 40-49, 50-59, and 60+.
Number Pick-Up
** Early Packet Pick Up will be Friday, May 5, from 2-4 p.m. in the CCMH Board Room just inside the main entrance **
Entry Fees
Entry Fees and Deadline Early Bird Registration fee for 5K Walk/Run is $25.00 by Friday, April 21, 2017, in order to guarantee a t-shirt. Day of Race Registration fee for 5K Walk/Run is $30. Children’s Fun Run is free (shirt not included). If you’d like to purchase extra shirts, please contact Rachel Arth at 542-1695 or rachelk@ccmhospital.org by April 21.
Registration
CCMH Foundation Superhero 5K Run/Walk
Mail Registration to: Carroll County Memorial Hospital , 1502 N. Jefferson Street, Carrollton, MO 64633 Checks Payable to: CCMH Foundation
Name:_________________________ Age:_____ Gender:____ T-shirt Size:_____
Address:_______________________ City:______________ State:___ Zip Code:__
Phone:______________ E-mail:_________________________________________
Emergency Contact: _______________________ Phone Number:______________
CCMH Superhero 5K Run/Walk Waiver
I know that running is a potentially hazardous activity. I should not enter or run in this event unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with participating in this event including, but not limited to, falls, contact with other participants, effects of weather (including high heat and humidity), traffic and the conditions of the road-all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Carroll County Memorial Hospital Foundation and Carroll County Memorial Hospital and all sponsors, their representatives and successors, for claim or liability of any kind out of negligence or carelessness on the part of the person named in this waiver.
Carroll County Memorial Hospital and its Foundation may take photographs for publicity purposes. By signing this form, you are consenting to the use of the images for use in our printed publications, media releases, and on our website or social media.
Signature of participant:____________________________________________________ Date:________________
Signature of parent/guardian:________________________________________________ Date:_________________ (If participant is under the age of 18)
