Join Mikey’s Way Foundation on June 1st for their
Miles for Smiles 5K
To Help Pediatric Cancer Patients
Location: Joel Barlow High School Cross Country Loop
100 Black Rock Tpke, Redding, CT
Cost: Pre Register at $25.00
Race Day $35.00
When: Saturday, June 1st
Time: 9am – noon
· 7:30 – 8:30am: Pre Registration packet pick up and Race Day
· 9am: 5K Starts RAIN or SHINE
· 10:30am: Post Race Snacks/Beverages
· 11am: Awards and Door Prizes
Pre-Register online at: startlineraceservices.com “Miles For Smiles”
Or mail form below
In consideration of acceptance of this entry into the “Miles For Smiles” 5K race, I the undersigned, intending to be legally bound, do hereby, for myself, my heirs, executors and administrators, irrevocably release and discharge the race director and officials, Mikey’s Way Foundation, Joel Barlow High School, Town of Redding, Redding Police Department, and any and all race sponsors and supporters, volunteers, and their respective agents, successors and assigns, from and against any damages, loss or other liabilities incurred by me arising out of my participation in said event, and I hereby irrevocably waive any claim for such damage, loss or other liability against any of the foregoing. I assume all risks with entering and participating in this event, including but not limited to falls, contact with other participants, effects of weather, including cold, high heat and/or humidity, traffic and off road conditions, and I understand and acknowledge that the race will take place regardless of weather conditions. I am fully aware that participation in the activities of this 5K (3.11 mile) race may cause others to suffer serious physical injury up to and including death. All such risks are known to and appreciated by me. I attest and verify that within the last six (6) months a licensed Medical Doctor has determined that I am sufficiently physically fit and trained for the completion of this event. Further, I hereby grant full permission to any and all the foregoing to use my photographs, videotapes, motion pictures, recordings, or any other record of this event for any legitimate purpose without compensation to me.
Please read the agreement above, fill out the form below. You can pre-register for the run by submitting this form on line with payment or mail form and check payable to Mikey’s Way Foundation, 2228 Black Rock Tpke, Suite 307, Fairfield, CT 06825.
All pre-registered payments must be received by May 30th. All pre-registered participants are guaranteed a Miles For Smiles t-shirt.
You may also turn this in to the registration table on the morning of the race.
First Name: ___________________________________________ Last Name: _________________________________________
Street: _________________________________________________ City: ___________________ State: ______ Zip: _________
Sex: ____________ Date of Birth: ___________ Email: __________________________________
Age on Race Day:_______ Payment Amount: $____________________
T-shirt Size: M L XL (All adult sizes)
Signature (Parent / Guardian must sign for minor)