Registration

 

Kiwanis 5K Run/Walk for Riley

First Methodist Church – 8th & Lafayette

– Columbus, IN.

Saturday – December 3, 2016

10:00 A.M.

 

 

 

——————————————————————————————–

Kiwanis Santa Run for Riley Children’s Hospital

 

Kiwanis Club of Columbus – Meridian will host the 2nd Annual 5K Run/Walk for Riley Children’s Hospital starting at the First United Methodist Church – Columbus IN. on Saturday December 3, 2016 at 10:00 am.  This event is a 5K run/walk thru Columbus Indiana as a fund raiser for Riley Hospital for Children, Indianapolis Indiana. Registration fee for walkers and runners will be $10.00 USD. For funds raised (registration + sponsorships) equaling $20.00 or more, the participant will receive a Santa Clause Suit.

 

All proceeds raised by this event will go to Riley Hospital for Children

 

Registration can be online @ www.kducks.com or in person the day of the event beginning @ 9:00 am at the First United Methodist Church.  All participants will be required to submit the attached entry form at the time of the event.

——————————————————————————————–

Kiwanis Santa Run for Riley Hospital for Children

 

Name________________________________________

 

Address ___________________________________________

_____________________________________________________

Email ____________________

Age ____     Gender ______

Entry Fee         $  ________

Sponsorships   $  ________

 

 

In consideration of acceptance of my entry, I hereby release, discharge and agree to hold free and harmless any sponsors, officials of organizers of this event and each of them together with their successors, assigns, officers, agents, and employees form any and all liability for injuries to property or person suffered by me as a result of my participation in this event. By execution of this waiver, I assume all risk associated with my participation in this event, including, but not limited to falls, the effects of weather, traffic and road conditions, all such risks being known and appreciated by me.

 

 

 

 

______________________________________________________________________

Signature of Participant/Parent or Guardian if under 18

 

Register on line through the form below or to register manually CLICK HERE to print the registration form.

Name (required)

Street (required)

City (required)

State (required)

Zip Code (required)

Email (required)

Age (required)

Gender (required)
 Male Female


In consideration of acceptance of my entry, I hereby release, discharge and agree to hold free and harmless
any sponsors, officials of organizers of this event and each of them together with their successors, assigns,
officers, agents, and employees form any and all liability for injuries to property or person suffered by me as a
result of my participation in this event. By execution of this waiver, I assume all risk associated with my
participation in this event, including, but not limited to falls, the effects of weather, traffic and road conditions,
all such risks being known and appreciated by me. I verify that I am physically fit and sufficiently trained for the
completion of this event and that my physical condition has been verified by a licensed medical doctor.

Digital Signature of Participant/Parent or Guardian if under 18 - type your full name in the box below (required)

 

For Pledge sheet to solicit sponsors CLICK HERE.