3rd Annual Soul to Sole 5K Run/Walk & Children’s Fun Run

To benefit the Michael J. Fox Foundation

Location: 455 Regency Park Dr O’Fallon, IL (Egg and I Parking Lot)

Date:9am Sunday, April 24, 2016 RAIN OR SHINE

Packet Pick Up:April 22, 2016 5pm-7pm Running Start 3220 Greenmount Crossing Shiloh, IL Race Day: 7AM-8AM

Start Time:9:30 AM Children’s Fun Run will follow immediately upon completion of the 5K Race/Walk

Registration:$25.00 by April 12, 2016; Lateregistration $30.00 after April 12 or on race day

Virtual Registration: $25.00 by April 12, 2016

Mile Dedication: $50.00 (First three will be accepted) In Honor or Memory of:

______(print name clearly)

Overall Awards: Male/Female: 1st Place $75.002nd Place $50.003rd Place $25.00

Divisions: 5K-Top Overall Male & Female; Age Groups (M&F); 10 & Under: 11-14; 15-19; 20-29; 30-39-; 40-49; 50-59; 60 & Over

Medals for top 3 Male/Femalefinishers in each age division! All kids who participate in the Children’s Fun Run will receive a medal. All Participants will receive a runners goodie bag, after-run refreshments, and snacks! First 300 Participants will receive a race day shirt!

5K RUN/WALK and Children’s Fun Run Registration Liability Waiver Form

Each participant or participant’s guardian must complete and sign this form.

Name:______Address:______

City, State, Zip Code: ______Email: ______

Gender Male/Female (circle one) Age as of 04/24/2016____ Race 5K Run/Walk or Fun Run (circle one)

Shirt Size (circle one) Adult: S M L XL XXL Child: S M L XL Available to the first 300 participant’s

RELEASE OF LIABILITY (Adult)

Waiver: In consideration of the acceptance of this entry, I waive all claims for myself and my heirs against the sponsors, cooperating and coordinating groups and any individuals associated with this event and will hold them harmless for any and all injuries which may result from my participation. I hereby give my permission to the media to use my name and photograph in the newspaper, broadcast and/or telecast of this event without limitation or obligation. I certify that I am physically fit for this event and understand the risks involved by participating in this event.

Date:______Signature:______

Parent / Guardian Consent Form and Liability Waiver

I, ______, grant permission for my child, to participate in the Soul to Sole 5K Run/Walk & Fun Run. As parent and/or legal guardian, I remain legally responsible for my personal actions taken by the above named minor (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors and assigns, to hold harmless and defend the Soul to Sole 5K, its officers, directors and agents, or representatives associated with the event, arising from or in connection with my child attending the event or in connection with my illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the Soul to Sole 5K. its officers, directors and agents, or representatives associated with the active for reasonable attorney’s fees and expenses arising in connection therewith. Medical Matters: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.

Date:______Signature:______

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Mail checks payable to Soul to Sole PO Box 697 O’Fallon, IL 62269