Hotter than Haiti Fun Run 1 mile, 5k or 10k
Packet pick up & Day of Registration: 8-8:50am
Race Time: 9am
Location: Wellsville Square
Registration Fee: $12 adults, $8 children (10 & under)
Each registration
fee includes a Runners Shirt, 1 Raffle Ticket, Snacks and Drinks.
Additional raffle
tickets can be purchased for $1 and there will also be awesome prizes to bid
on. Donations will also be accepted for
Reach Out to Haiti Orphanage and they are tax deductible.
All proceeds will
go to help rebuild the orphanage at Ruuska Village, provide food, clothes, and
an education to children in Haiti. More
information about Reach out to Haiti Orphanage can be found at
reachouttohaiti.com.
Participant
Information:
Name:
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Phone:
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Email:
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Shirt Size Please circle Youth Small Youth Med
Adult Unisex
S M L
XL XXL
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Address:
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City:
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State:
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Zip:
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Register by August
31st to guarantee a preferred shirt size. On-line registration is available where you
can pay by paypal at haitifunrun.blogspot.com or you can
Make Checks
payable to: Reach Out to Haiti
Mail to: Mandi
McBride 6910 S. 4000 W Wellsville, UT 84339
Release of Liability Statement
The undersigned Participant
understands and is aware of the risks and hazards associated with running
races. I represent that I’m physically
fit and capable of running in this Event and further represents that if I have
any questions regarding my fitness for the event, I’ve consulted with a
physician. I assume all risks associated
with my participation in the event, even if those risks are caused by the negligence
of someone else. I discharge and release
forever the City of Wellsville, Reach out to Haiti Organization and any other
sponsor or organizers together with their respective offices, agents, employees
and other representative of any liability whatsoever for the claim for damage,
injury or death that may happen during my participation in the event. I understand that there is no obligation to
provide me with medical care as a result of my participation in the event but
that if such emergency care is provided all the terms of the Agreement shall
apply. The organizers of this event may
use my likeness, records, or photograph for any purpose without compensation to
me.
Signature of
Participant:_______________________________________________
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Date:_________
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Signature of
Parent or Guardian if under 18 years of age:_______________________
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Date:_________
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