Registration Form

‘It’s an AG-venture!’ 5K Race

When:            Sunday, May 17, 2015

Where:           Huntingdon County Fairgrounds

                                    Parking in the lot behind the Grandstand

Time:              2:00 pm (Runners and Walkers)

                                    Registration begins at 12:30 pm by the Main Office

Cost:               $20 per participant (includes t-shirt)

                                   

5K Race Awards:

Medals will be awarded to the top 3 runners in each age group:

            Under 12                    30-39

            12-14                          40-49

            15-19                          50-59

            20-29                          60 and older      

           

My name is Sarah Jefferis, the 2014-2015 Huntingdon County Fair Queen.  As part of my duties, I promote the Huntingdon County Fair, agriculture, farm safety along with connecting our youth of today with the knowledge of becoming leaders tomorrow.  Our fair is very proud of youth and always show it so I would like to do the same.  For my community service project, I chose to organize a 5K run/walk with the proceeds benefitting the state scholarship fund that helps the youth pay for their further education to become leaders of tomorrow.

Your completed registration and check needs to be postmarked by Monday April 20, 2015.  Please mail your information to     Sarah Jefferis     112 Shelton Avenue     Alexandria, PA 16611.

T-shirt size:     Small               Medium                Large                X-Large

           

                                    Walker                                                   Runner

Name:___________________________________________

Address:_________________________________________

Age (on Race Day):______                                 Gender: Male or Female

Phone:___________________     Email:_____________________________________________

Cost: $20     Cash____    Check Number_____    Checks payable to Sarah Jefferis

Waiver: I know that running/walking a trail race is a potentially hazardous activity.  I should not enter and run/walk unless I am medically able and properly trained.  I also know that there will be hazards, debris, and poor footing on the course and assume the risk for running/walking on it.  I also assume any or all other risks associated with running/walking or attending the race including but not limited to falls, contact with other participants, the affect of the weather, getting lost, wildlife and insect attacks and all such risks being known to and appreciated by me.  Knowing these facts, and in consideration of your accepting my entry fee, I hereby for myself, my heirs, executers, administrators or anyone else who might claim on my behalf, covenant not to sue and waive, release and discharge Sarah Jefferis, the Huntingdon County Fair Board, all municipalities in which the event is held, course officials all other organization directly or indirectly associated with the race, any and all sponsors including their agents, employees, assigns or anyone acting for on their behalf or anyone else associated in any way with the race, for any or all claims or liability for death, personal injury or property damage of any kind or in the course of , my participation in the event.  This waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. BY SIGNING THIS, I ATTEST THAT I HAVE READ AND UNDERSTAND THIS WAIVER.

Participant Signature:_______________________ Date ___/____/____

Signature of Guardian (if under 18 years of age):__________________________________

Emergency Contact Name and Phone Number:________________________________________