3 3 3 rd rd rd rd Annual EMC Annual EMC Annual EMC Annual EMC Panther Panther Panther Panther’ ’ ’s Run s Run s Run s Run Registration Form Optional online registration available at www.pretzelcitysports.com Online registration closes at midnight on 6/1/2016 Runner’s Information: (One Runner per Registration Form) Last Name: ________________________________ First Name: ________________________________ [ ] Male [ ] Female Date of Birth: ___________________ Age: ________ Address: __________________________________ City: __________________________ State: _______ Zip: _________ Phone: ______________________ Email: _____________________________________ [ ] 5k Run [ ] 1 Mile Fun Run Register by 5/13/2016 to guarantee your T-shirt , after that it will be while supplies last. Size: (check one) [ ] Adult S [ ] Adult M [ ] Adult L [ ] Adult XL [ ] Child S [ ] Child M [ ] Child L Are you an EMC Student? [ ] Yes [ ] No Grade: __________ How did you hear about this event? [ ] EMC Website/Reporter [ ] Pretzel City Sports [ ] Facebook [ ] Other Waiver of Release & Liability : I know that running is potentially hazardous. I should not enter and run unless I am medically able and properly trained. I agree to abide by all decisions of race officials relative to my ability to safely complete the run. I assume all risks associated with running. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act in my behalf, waive and release the EMC H&S Assoc., EMC Elementary School, Souderton School District, the Boroughs of Souderton & Telford and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. NOTE: Volunteers will be on hand to guide participants, but some roads will be open to traffic. I have read & understand the above waiver. Signature: __________________________________ Date: _________________ Parent’s Signature if under 18 years of age: ___________________________ Date: __________ Registration by 5/13/2016: [ ] 5K $20 [ ] 1 Mile Fun Run $10 Registration after 5/13/2016: [ ] 5K $25 [ ] 1 Mile Fun Run $15 Race/Walk Registration Fees: ________________ Please mail completed form postmarked by 5/13/16, to: EMC Elementary School Attn: EMC Panther’s Run 143 S School Lane, Souderton PA 18964 Checks payable to “EMC Home & School Assoc.” EMC Elementary School Home & School Assoc. Presents The 3 The 3 The 3 The 3 rd rd rd rd Annual Annual Annual Annual EMC Panther EMC Panther EMC Panther EMC Panther’ ’ ’s Run s Run s Run s Run 5k & 1 Mile Fun Run 5k & 1 Mile Fun Run 5k & 1 Mile Fun Run 5k & 1 Mile Fun Run Saturday, June 4, 2016 9:00 am EMC Elementary School 143 S. School Lane Souderton PA 18964 Rain or Shine Event Benefiting the Students of EMC Elementary School Event Schedule: 8:00am Registration / Pre-Registration Check-In 9:00am 1 Mile Fun Run Begins 9:30am 5k Run Begins Timing by Pretzel City Sports