21st Annual Run for Children Certified 5K Run / Walk

To Benefit the Child Life Program at

Stony Brook University Medical Center

Sunday, October 18, 2009

Gelinas Jr. High School, Setauket, NY

Registration: 7:30 to 9:00 AM Race Begins at 9:30 AM

Registration Fees: Pre-Registration Special! - $20 or $50 in pledges received by October 12, 2009 Day of Race - $25

Top Quality Commemorative T-Shirts Guaranteed to all Pre-Registrants!

What is Child Life?

Hospitalization is a difficult experience for all patients, but particularly for children. Unfamiliar faces and surroundings coupled with unpleasant procedures can be frightening for children. The Child Life Program strives to normalize the healthcare experiences for pediatric patients and their families and reduce the stress associated with illness and hospitalization. Certified Child Life Specialists provide patients with procedural support, preparation and education, medical play therapy and diversionary activities.

Kids need more than medicine to get well!

All proceeds from the Run for Children will go directly towards reducing the trauma and anxiety the children experience while in the hospital. Funds will be used to purchase new games, toys, movies, arts and crafts, and playroom supplies. They will also support activities such as Animal Assisted Therapy,

Music Therapy, birthday parties, and much more!

MAIL IN REGISTRATION FORM

Name ______Age ______qMale qFemale

Address ______Phone Number ______

City, State ______Zip ______E-Mail ______

Waiver: In signing this form for myself (or participant below if he or she is under 18), I understand that I agree to absolve Stony Brook University Hospital, the Town of Brookhaven, and all sponsors, be they individuals or organizations, singly, or collectively, of all blame for any injury, misadventure, harm, loss or inconvenience suffered in any or the activities associated with the said event. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event, and that my physical condition has been verified by a licensed Medical Doctor. I grant full permission for organizers to use my name, likeness or voice and photographs, videotapes, or quotations from me in accounts and promotions in any medium of this event.

Signature ______

Parent/Guardian ______

(if under 18)