4TH Annual Soul to Sole 5K Run/Walk & Children’s Fun Run

To benefit The Michael J. Fox Foundation

Location: Race will begin and end at The Egg & I, 455D Regency Park, O’Fallon, IL 62269

Date: Sunday, April 30, 2017 RAIN OR SHINE

Packet Pick Up:April 28, 2017 5pm-7pm Toolen’s Running Start 3220 Green Mt. Crossing Dr., O’Fallon, IL 62269Race Day: 7:30AM-8:30AM

Start Time: 9:00 AM Children’s Fun Run will follow immediately upon completion of the 5K Race/Walk

Registration: $25.00 by April 16, 2017late registration: $35.00 after April 16 or on race day

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 runner goodie bag, after-run refreshments, and snacks! First 300 Participants will receive a race day shirt!

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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 04/30/2017____ 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:______

Email: Phone: 314-296-6230 Visit Us On Facebook:

Mail checks payable to Team Gateway To A Cure 7733 Forsyth Blvd, Suite 1100, Clayton, MO 63105