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Colors For Kids 5K FUN RUN INDIVIDUAL REGISTRATION  AND  WAIVER  FORM  

Date: Saturday April 26, 2014 Time: Registration at 7:00AM Zumba Warm-Up at 8:00AM Run Starts at 9:00AM Entry Fees: Pre-Registration (through April 1, 2014) $30 Individual $25 per person for Team of 4 or more. After April 1, 2014 $35 Individual $30 per person for Team of 4 or more Location: Brandywine Junior- Senior High School Cross Country Track 1700 Bell Road Niles, MI 49120 Mail your registration by 4/1/14 to Niles Service League PO Box 704 Niles, MI 49120 Make Checks Payable To: Niles Service League T-Shirts: Each pre-registered participant will receive a commemorative t-shirt. T-shirts are not guaranteed for late or race-day registrants. Proceeds: All proceeds will go directly to The Niles Service League, which benefits the children of the Brandywine, Buchanan and Niles area. *Waiver: I, for myself or as parent or guardian, hereby assume all the risks and hazards incidental to the conduct of the activities. I understand that no insurance coverage is provided by the race coordinators and sponsors. I assume all risks associated with running in this race including but not limited to, falls, contact with other participants, the effects of the weather and conditions of the course. I further give permission for proper emergency care to be rendered to myself or child should I not be available or able to give such permission. All fees are nonrefundable. Race will take place rain or shine. In the event of extreme weather conditions or some other unforeseen act of God that may prohibit the race, all fees are nonrefundable. Having read this release and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act in my behalf waive and release Niles Service League, and their representatives and all other sponsors of the race, or any other persons assisting with the race, from all claims and liabilites of any kind arising out of my participation in the race even though the liability may arise out of negligence or carelessness on the part of the persons referred to in this waiver. I also give permission for the free use of my picture in broadcasts, newspaper, posters, advertising, social media, etc. for any future event given by the Niles Service League. Participant Name ______________________________________ Address ______________________________________________ City __________________ St ______ Zip ________ Phone: _________________________________ Age ________

Male _______

Email: ______________________________________

Female ________

Adult T-Shirt Size (circle one): Small Medium Large XLarge XXLarge *I HAVE READ THE WAIVER (MUST INITIAL)

AGREE _____________

**Consenting Adult for minor participants under 18 years of age __________________________________________________

Niles Service  League   PO  Box  704  Niles  MI    49120   Contact  Ph#    269-­‐591-­‐1246   http://nilesserviceleague.yolasite.com  


Colors For Kids 5K FUN RUN

TEAM REGISTRATION  AND  WAIVER  FORM  

Date: Saturday April 26, 2014 Time: Registration at 7:00AM Zumba Warm- Up at 8:00AM Run Starts at 9:00AM Entry Fees: Pre- Registration (through April 1, 2014) $30 Individual $25 per person for Team of 4 or more. After April 1, 2014 $35 Individual $30 per person for Team of 4 or more Location: Brandywine Junior- Senior High School Cross Country Track 1700 Bell Road Niles, MI 49120 Mail your registration by 4/1/14 to Niles Service League PO Box 704 Niles, MI 49120 Make Checks Payable To: Niles Service League T-Shirts: Each pre-registered participant will receive a commemorative t-shirt. T-shirts are not guaranteed for late or race-day registrants. Proceeds: All proceeds will go directly to The Niles Service League, which benefits the children of the Brandywine, Buchanan and Niles area. *Waiver: I, for myself or as parent or guardian, hereby assume all the risks and hazards incidental to the conduct of the activities. I understand that no insurance coverage is provided by the race coordinators and sponsors. I assume all risks associated with running in this race including but not limited to, falls, contact with other participants, the effects of the weather and conditions of the course. I further give permission for proper emergency care to be rendered to myself or child should I not be available or able to give such permission. All fees are nonrefundable. Race will take place rain or shine. In the event of extreme weather conditions or some other unforeseen act of God that may prohibit the race, all fees are nonrefundable. Having read this release and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act in my behalf waive and release Niles Service League, and their representatives and all other sponsors of the race, or any other persons assisting with the race, from all claims and liabilites of any kind arising out of my participation in the race even though the liability may arise out of negligence or carelessness on the part of the persons referred to in this waiver. I also give permission for the free use of my picture in broadcasts, newspaper, posters, advertising, social media, etc. for any future event given by the Niles Service League. Team Name ______________________________________

Team Contact Person ________________________________

Team Contact Person Email & Phone# ______________________________________________________________________ Participant Name _______________________________________ Age ________

Male _______

Female ________

Address ______________________________________________ City __________________ St ______ Zip ________ Phone: _________________________________

Email: ______________________________________

Adult T-Shirt Size (circle one): Small Medium Large XLarge XXLarge *I HAVE READ THE WAIVER (**MUST INITIAL)

AGREE _____________

**Consenting Adult for minor participants under 18 years of age _______________________________________________ Niles Service  League   PO  Box  704  Niles  MI    49120   Contact  Ph#    269-­‐591-­‐1246   http://nilesserviceleague.yolasite.com  


Colors For Kids 5K FUN RUN

TEAM CAPTAIN  CONTACT  FORM  

Date: Saturday April 26, 2014 Time: Registration at 7:00AM Zumba Warm-Up at 8:00AM Run Starts at 9:00AM Entry Fees: Pre- Registration (through April 1, 2014) $30 Individual $25 per person for Team of 4 or more. After April 1, 2014 $35 Individual $30 per person for Team of 4 or more Location: Brandywine Junior- Senior High School Cross Country Track 1700 Bell Road Niles, MI 49120 Mail WITH your Participant Team registration by 4/1/14 to Niles Service League PO Box 704 Niles, MI 49120 Make Checks Payable To: Niles Service League T-Shirts: Each pre-registered participant will receive a commemorative t-shirt. T-shirts are not guaranteed for late or race-day registrants. Proceeds: All proceeds will go directly to The Niles Service League, which benefits the children of the Brandywine, Buchanan and Niles area.

TEAM NAME: ____________________________________________________ #MEMBERS ON TEAM _____________ YOUR NAME: ____________________________________________________ YOUR CONTACT INFORMATION: ADDRESS ______________________________________________ CITY _____________________ ST ______ ZIP __________ TELEPHONE __________________________________________ EMAIL ____________________________________ PLEASE LIST ALL PARTICIPANTS THAT ARE PART OF THIS TEAM: **NOTE** EACH PARTICIPANT MUST RETURN AN ENTRY FORM WITH THE WAIVER INITIALED/AGREED _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ Niles Service  League   PO  Box  704  Niles  MI    49120   Contact  Ph#    269-­‐591-­‐1246   http://nilesserviceleague.yolasite.com  

5k Color Run  

Niles Service League

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