LohffSchumann Moorehead Park Trail Run/Walk Saturday, October 1st Start Time 9:00 a.m. If interested in participating please return registration form & payment to LohffSchumann Memorial Community Center P.O. Box 500 Holstein, IA 51025 by September 23rd to receive Tshirt
Name: ________________________________ Address: ______________________________ Phone: ________________________________ Email: ________________________________ Emergency Contact: ____________________ Phone: ________________________________ $25 to participate includes tshirt $10 for student cross country runners SM______Med_______LG_______XL_______ Runner______________Walker_____________ Race will be approximately 4 miles of gravel and wooded trail running or walking with beautiful sites & nature throughout! Proceeds will be evenly divided between LohffSchumann & Moorehead Park for continuing upkeep and improvements I hereby certify the following: (1) I am physically fit and have received medical clearance to participate in Lohff Schumann Memorial Community Centers 5K walk/run, 10K run, and/or Dodgeball Tournament. (2) In consideration for my application to participate in the Lohff Schumann Memorial Community Centers 5K walk/run, 10K run, and/or Dodgeball Tournament being accepted, I, on behalf of myself, my heirs and assigns, and my estate, hereby waive and forever discharge the sponsors, organizers, affiliates, as well as their agents and employees from any and all claims that may accrue as the result of my participation, and (3) I herby grant Lohff Schumann Memorial Community Center specific permission to reproduce, publish, circulate, copyright or otherwise use any and all photographs and/or video of my and/or my family, taken at the Glow Dodge & Run event. Participant's Signature_____________________________________________________ Date__________________ If under 18, Parent's or Guardian's Signature________________________________________________________
4 Miles of beautiful trail running!