Trick or Trot 5K Run/Walk
All proceeds benefit the Teddy Bear Fund Drive
Race sponsored by Indiana High School Student Government
Saturday, October 31, 2015
Mack Park Pavilion
752 South Sixth Street
Indiana, PA
9:00 am Walk-In Registration; 9:30 am for Pre-Registered Sign-Ins
Race starts at 10:00 am
Send registration form with $15 by October 9, 2015; $20 afterwards
(Includes race and t-shirt; no guarantees on availability of shirts for late registrations)
Go to www.iasd.cc/domain/594 for a race course map and other information.
The race will be timed, but feel free to wear Halloween costumes for the Trick or Trot!
______
Name:______Age: ______
Event (circle one): 5K Run OR 5K Walk Gender (circle one): Male OR Female
Street Address: ______
City: ______State: ______Zip Code: ______
Phone Number: ______E-mail Address: ______
Shirt Size: S__ M__ L __ XL __ XXL ___ Youth Sizes: S__ M__ L__
I understand that running and/or walking in a road race is a potentially hazardous activity. I should not enter and run or walk unless I am medically able and properly trained. I assume all risks associated with running in this event including, but not limited to: falls, the effects of the weather, including cold, snow and/or ice, high heat and/or humidity, traffic and conditions of the road/trail, all such risks being known and understood by me. In acceptance of this entry for this event, I hereby release Indiana Area School District, Indiana High School Student Government Association, Mack Park, Indiana Regional Medical Center, and any of their associates or representatives involved in the race, from any and all contentions or claims of damages or injuries suffered by myself and/or registered program participants as a result of participation in this event. I attest that I or the person I am registering for this event is physically able to participate in this event.
Participant Signature: ______Date: ______
Parent/Guardian Signature: ______Date: ______
(Required if participant is less than 18 years old)
If you have any questions, please contact Margaux Marcus, Race Director, by e-mail at or Michael Bertig, Indiana Student Government Advisor, by e-mail at .
Mail this application sheet, along with cash or check, payable to Indiana Senior High School, to:
Indiana Senior High School
c/o Michael Bertig
450 North Fifth Street
Indiana, PA 15701
Trick or Trot 5K Run/Walk
All proceeds benefit the Teddy Bear Fund Drive
Sponsored by Indiana High School Student Government
Saturday, October 31, 2015
Mack Park Pavilion
752 South Sixth Street
Indiana, PA
Individual Rate $15 by October 9, 2015, $20 otherwise
(Includes race and t-shirt; no guarantees on availability of shirts for late registrations)
Feel free to wear Halloween costumes for the Trick or Trot!
Go to www.iasd.cc/domain/594 for a race course map and other information
Every year, the Student Government of Indiana High School participates in the Teddy Bear Fund Drive. Eighty percent of the money raised from the Teddy Bear Fund Drive goes to the pediatric ward of the Indiana Regional Medical Center, and the other 20 percent is given to Children’s Hospital. As part of the fundraising efforts this year, Student Government is coordinating the Trick or Trot 5K. This is the fourth annual 5K race that Student Government has sponsored. / Awards will be given in both men’s and women’s divisions for first, second, and third place overall. Awards for first, second, and third place in each age division.Age divisions: 9 and under, 10-12, 13-14, 15-18, 19-29, 30-39, 40-49, 50-59, 60+
Parking available at Mack Park
Race registration and starting line will be located at the Mack Park Pavilion
All levels of runners and walkers welcome
Complimentary snacks and drinks will be available after the race
No dogs, pets, roller blades, or similar items for safety reasons