The Waterloo, IL Optimist Club 14th Annual 5K Competitive Run & 5K Fun Walk

Driving Directions

From the North

255 South

Route 3 South

Left on North Market

Left on East 1st St.

Please donate a pair

of used running shoes for our collection efforts.

We will be donating to the less fortunate.

Thank you,

The Waterloo Optimists

The Waterloo, IL Optimist Club 14th Annual

5K Competitive Run & 5K Fun Walk

Friend The Waterloo of Youth

Serving the Community Since 1954

Date: August 27, 2016 Place: Rogers Elementary School

Start Time: 8:00am 200 N Rogers St

Waterloo, IL 62298

Divisions for Male & Female participants:

Age: 14 & Under	25-29	40-44	55-59	80 & Over
15-18	30-34	45-49	60-69	Heavy Weight 225 LBS +
19-24	35-39	50-54	70-79	Wheelchair

Entry INFO:

$20 registration if postmarked by August 20th
$25 registration if postmarked after August 20th
Race T-shirts guaranteed for those postmarked by Aug 20th

PRINT THIS FORM, FILL OUT, and SEND TO:

Waterloo Optimist Club c/o Trevor Gahn

1714 Ontario Drive

Waterloo, IL 62298

Make checks to: Waterloo Optimist Club

Race Director: Trevor Gahn (618) 560-8657 or Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Assistant Race Director: Brad Karn (618) 939-3970 or Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Race Day Registration: 6:45-7:30AM (Packet pickup at check in/registration)

Proceeds: All proceeds will benefit local youth programs

Refreshments: Provided before and after the race

Bathroom and Changing Areas: Available at Rogers Elementary School

5K Course: City streets with rolling hills, out and back

Race will be held regardless of the weather, delayed start for dangerous weather

Awards Presentation and Attendance Prizes at the completion of the event

Trophies for 1st, 2nd and 3rd place finishers, plus 1st overall finishers for men and women

HOLD HARMLESS CLAUSE / WAIVER & RELEASE FROM LIABILTY

NAME (print)_____________________________ Age(race day)_ Sex_ Heavyweight Wheelchair__

Street________ City State_ Zip______

Phone ()-____

Shirt Size: YS YM YL S M L XL XXL

Email_____________________________________________

Youth Only-School Affiliation _____________________

Team___________________ Coach___________________

Please read this form carefully and be aware that in registering and participating in this event you will be waving all claims for injuries you might sustain arising from this event. As a participant in the Waterloo Optimist Club 5K Run/Walk Race for Youth, I recognize and acknowledge that there are certain risk of physical injury and I agree to assume the full risk of any injuries, including death, damages or loss which I may sustain as a result of participating in any and all activities connected and associated with such event. I agree to waive and relinquish all claims I may have as a result of participating in the event against the Waterloo Optimist Club and its members. I do hereby fully release and discharge the Waterloo Optimist Club and its members from any and all claims from injuries, including death, damage or loss, which I may accrue due to my participation in this event. I further agree to indemnify and hold harmless and defend the Waterloo Optimist Club and its members from any and all claims resulting from injuries, including death, damages and losses sustained by me and arising out of, connected with, or in any way associated with the activities of the event.

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Participant Signature

_____________________________________________

Date

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Signature Of Parent Or Guardian (If Under 18)

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Date