Mail In Registration
KEEP CALM & DIVE ON 5K RUN/WALK
KYLE SISSON FUNDRAISER
Saturday, June 22, 2013
Race Day Schedule:
Enter me in the:
6:45 am
7:30 am
8:30 am
9:00 am
- Check In Registration Opens
- 5K Race Begins
- 1M Race/Walk Begins
- 5K Run Awards
( ) 5K Race
( ) 1M Run/Walk
(will be race day registrations)
Race Location:
T-Shirt Size:
( ) S
( ) M
( ) L
( ) XXL is $2.00 extra
Lecanto High School
3810 W. Educational Path
Lecanto, FL 34461
T-shirts are only guaranteed if registered by the deadline. If extra shirts are ordered, it will be first come/first served beyond deadline, June 8th, 2013 at midnight.
5K Awards
Name:
Address:
City:
Email:
Age:
Gender:
DOB:
Contact #:
State:
Zip:
Overall Male/Female (gift card or basket)
Overall Masters (40+) Male/Female (gift card or basket)
Ribbons 2 Deep in 6 year Age Groups
13 under, 14-19, 20-29, 30-39, 40-49, 50+
Entry Fee:
Registration (now thru June 8) (Bibs will be used)
$25.00
$20.00
$15.00
$15.00
Day of Race (all events)
Adults (18+-non high school)
Students/children/below 18
1M Race/Walk
RELEASE WAIVER: I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event including high heat and humility, traffic and the conditions of the road, all such risks being known and appreciated by me. I understand that bicycles, skate boards, baby joggers, roller skates or blades, animals and radio headsets are not allowed in the race and I will abide by these guidelines. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I for myself and anyone entitled to act on my behalf, waive and release the CCSB, Lecanto High, the sponsor organization, LLC for timing and any subcontractors or any other group associated with this event from any responsibility for injury or serious medical concern.
My signature acknowledges my understanding of risk waiver release, etc. for myself if 18 or older or for my child who is 17 or younger.
Race Contact Information:
Charity Information:
Kyle Sisson Sun Trust Fund
Additional Information:
Signature:
Date:
Kyle Sisson was seriously injured in a dirt bike accident on 2/16/13, one day after his 16th birthday. He suffered a spinal cord injury and is at Shephards Center in Atlanta, GA working towards recovery. All proceeds will go to Kyle's Sun Trust fund account to help cover Medical and travel expenses for him and the Sisson family.
Make Checks Payable to: LECANTO HIGH SCHOOL - 5K
Amount Enclosed
Race Applications are due by June 8th if want guarantee of T shirt
Send Race Applications to:
Online Registration:
Becky Harris
active.com
Lecanto High School
(type in Keep Calm & Dive On in search engine. There will be an additional fee for active.com)
3810 West Educational Path
Lecanto , Florida 34461