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Chick-fil-A Shape Up & Win - 5k Run / Walk / Tot Trot
Hosted by First United Methodist Church of Stuart
Saturday, January 20, 2018
Proceeds to support the Chick-fil-A WinShape Camp in our community.
5k race begins at 7:30 am in Memorial Park in Downtown Stuart, FL. Tot Trot for ages 10 and under. Tot Trot begins at 8:30 am.
$30.00 Pre-registration for 5k (Guarantees a shirt)
$35.00 Pre-registration plus childcare (for one hour if parent or guardian is running this 5k. Must be pre-registered.)
$40.00 race day registration for 5k (Does not Guarantee you a shirt)
$5.00 tot trot for children 10 and under (no shirt included)
Packet Pickup will be Thursday, January 18, 2018 from 12 pm until 6 pm located in the Fellowship Hall of First United Methodist Church of Stuart (1500 S Kanner Hwy, Stuart, FL 34994)
Name:____________________________________________ Gender: M / F (circle one) Address:________________________________________________________________________________________
T - Shirt Size:________________ Emergency Contact Name/Number:____________________
Tot Trot Runner Name(s) & Age(s):___________________________________________________________________
I hearby express and affirmatively state that I, or my child named herein wish to participate in the above stated activity. I realize that participation in this activity involves risk of injury including but not limited to loss of future earning capacity, loss or damage to personal property, various degrees and severity of injury, all other possible risks of injury and even death which occur by reason of me/my child’s participation and release the First United Methodist Church of Stuart, MCM Timing, City of Stuart, Chik Fil A, Winshape Camps, or other sponsors or affiliates of this race, its agents and employees there from. I intend to be legally bound, and do hereby, for myself, my heirs, and executors, waive and release any and all rights and claims for damages which I may have or which may hereinafter accrue to me. If I, or participant I represent, should suffer injury or illness I authorize officials of race to use their discretion to be transported to a medical facility and I take full responsibility for this action. I voluntarily choose to participate, or allow my child to participate, assuming all risks. I hereby grant full permission to any and all of the foregoing to use any photographs, videotapes, or any record for this event for any purpose.
Signature of Parent (if under 18):____________________________ Date:______________________________________
Please Make checks payable to FUMC Stuart. 1500 S. Kanner Hwy, Stuart, FL 34994.
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