CIRCLE SHIRT SIZE: YS YM YL S M L XL 2X 3X ■ MALE ■ FEMALE Print Name: _______________________________________________ Date of Birth: _______ /_______ /____________ Address: __________________________________________________ email: ___________________________________ City: ________________________ State: ______ ZIP: ____________ Phone: __________________________________ Release & Waiver: I know that running is a potentially dangerous activity and that I should not enter this event unless I am medically able and properly trained, and that physical injury, illness and even death may result from risks inherent in this sport. I assume all risks associated with participating in this event, including, but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the roads/trails and traffic on the course. Having read this RELEASE & WAIVER and in consideration of the acceptance of my entry, I, on behalf of myself and my representative and successors in interest, release and agree to indemnify, defend and hold harmless, even though any risks may arise out of negligence or carelessness on their part, S&S DRUG and all sponsors of this event and all agents, employees and representatives of the above, from all claims, suits, liabilities and actions. I grant permission for interested persons to photograph and record my participation in this event for publicity. Signature: ________________________________________ Date: _______ /_______ /____________ Must be signed by a parent or guardian if the participant is under the age of 18. S&S DRUG COLOR OUT CANCER COLOR RUN PLEASE PRINT CLEARLY & FILL OUT THE REGISTRATION FORM BELOW 2019 COLOR RUN PLACE: Beloit, Kansas DATE/TIME: Saturday, May 25; Registration at 7:00 am; Run Starts at 8:00 am in front of S&S Drug, 110 S. Mill Street COURSE: Begins in front of S&S Drug, goes over the bridge to Chautauqua Park and around loop, back to Campbell to 15th Street to Mill Street and back to S&S Drug. FOR MORE INFO: Contact Heather Johnson at S&S Drug, 785-738-2287, or email Heather at: [email protected] To Pre-Register (postmarked by May 10, 2019), mail or bring form to S&S Drug, 110 S. Mill or 113 S. Mill, Beloit, Kansas 67420. Make check payable to S&S Drug Color Run with “Color Out Cancer Color Run” in memo line. DONATION: Pre-registration is $30 (postmarked by May 10); Children 10 & Under - $15. Race-Day Registration (or later than May 10) is $25 - no shirt. All proceeds go to Breast Friends Foundation of Mitchell and Osborne County to help local community members fighting all types of cancer. All pre-registrations over the age of 3 will receive a t-shirt. PACKETS: Race Packets can be picked up starting on Thursday, May 23, at S&S Drug Home Health. S&S DRUG MAY TWENTY FI F T H T W E N T Y N I N E T E EN
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CIRCLE SHIRT SIZE: YS YM YL S M L XL 2X 3X ■ MALE ■ FEMALE
Print Name: _______________________________________________ Date of Birth: _______ /_______ /____________
Address: __________________________________________________ email: ___________________________________
City: ________________________ State: ______ ZIP: ____________ Phone: __________________________________
Release & Waiver: I know that running is a potentially dangerous activity and that I should not enter this event unless I am medically able and properly trained, and that physical injury, illness and even death may result from risks inherent in this sport. I assume all risks associated with participating in this event, including, but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the roads/trails and traffic on the course. Having read this RELEASE & WAIVER and in consideration of the acceptance of my entry, I, on behalf of myself and my representative and successors in interest, release and agree to indemnify, defend and hold harmless, even though any risks may arise out of negligence or carelessness on their part, S&S DRUG and all sponsors of this event and all agents, employees and representatives of the above, from all claims, suits, liabilities and actions. I grant permission for interested persons to photograph and record my participation in this event for publicity.
Signature: ________________________________________ Date: _______ /_______ /____________ Must be signed by a parent or guardian if the participant is under the age of 18.
S&S DRUGCOLOR OUT CANCER COLOR RUNPLEASE PRINT CLEARLY & FILL OUT THE REGISTRATION FORM BELOW
2019 COLOR RUNPLACE: Beloit, Kansas
DATE/TIME: Saturday,May 25; Registration at 7:00 am;Run Starts at 8:00 am in front ofS&S Drug, 110 S. Mill Street
COURSE: Begins in frontof S&S Drug, goes over the bridge to ChautauquaPark and around loop, back toCampbell to 15th Street to Mill Street and back to S&S Drug.
FOR MORE INFO: Contact Heather Johnsonat S&S Drug, 785-738-2287,or email Heather at:[email protected]
To Pre-Register (postmarkedby May 10, 2019), mailor bring form to S&S Drug,110 S. Mill or 113 S. Mill,
Beloit, Kansas 67420.Make check payable toS&S Drug Color Runwith “Color Out CancerColor Run” in memo line.
DONATION: Pre-registration is $30 (postmarked by May 10);Children 10 & Under - $15.
Race-Day Registration(or later than May 10) is $25 -no shirt. All proceeds go to Breast Friends Foundation of Mitchell and Osborne County to help local community members fightingall types of cancer.All pre-registrations over the ageof 3 will receive a t-shirt.
PACKETS: Race Packetscan be picked up startingon Thursday, May 23, atS&S Drug Home Health.
S&SDRUG
M AY T W E N T Y F IF T H TWENTY NINETEEN
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