1st ANNUAL

1^st ANNUAL
KEUKA COLLEGE 5K RUN AND WALK

WITH LAW ENFORCEMENT DIVISION

SATURDAY, MAY 10, 2003 AT 8:00AM

All proceeds to benefit United Way of Yates County. The race is sponsored by Keuka College and hosted by the Protective Service Office.

Description: Race starts and ends at Keuka College. Course makes a short loop around Keuka College Campus, and then goes off campus through local roads. Food and drinks at the end of the race are included. T-shirt will be given to every pre-registered entry. Additional shirts may be available on race day but not guaranteed. Directions to Keuka College are available online at www.Keuka.edu. Race starts at 8:00am, registration opens at 6:30am and ends at 7:45am on day of race. Pre-registered packets may also be picked up on Friday, May 9, 2003 from 3:00pm until 8:00pm at Keuka College Protective Service Office.

Entry Fee: $18.00 ($15.00 for Keuka College students) if postmarked by April 25 a T-shirt is guaranteed. Make checks or money orders payable to Keuka College (no cash or refunds). Return with signed form to Keuka College Protective Services, Attention: Joe Aymerich, Keuka Park, NY 14478. Keuka College staff and students can deliver form and payment to Protective Service Office.

Awards: Awards for runners in following categories:

-1^st/2^nd/3^rd Overall male and female

-1^st/2^nd/3^rd Law Enforcement Division (Male or Female)

-1^st/2^nd/3^rd in following age groups:

12 and under, 13 – 17, 18 – 28, 29 – 39, 40 – 49, 50 – 59, 60 +

No duplicate awards. Pick the category that applies to you and will result in best placement.

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Name: ____________________ Date of Birth: ______________

Keuka College Student: YES NO Age on Race Date: __________

Address: _______________________________________________________________

Telephone Number: ____________________

Circle One:

Age Group: 12& under 40 – 49

13 – 17 50 – 59

18 – 28 60+

29 – 39 Law Enforcement/Security

Name of Agency: ____________________

WAIVER:

I, the undersigned accept full responsibility for myself and for any injuries I may incur during the Keuka College 5K Run. I have read this application and I fully understand that participating in this event may be dangerous to my health. Sprained ankles and wrists, lacerations, bruises, broken bones, lighting strikes, insect bits, animal bits, collisions with vehicles, hypothermia, and heat exhaustion are real possibilities. I have trained sufficiently for this event. I will not hold any of the organizers, Keuka College, any of the race sponsors, volunteers, New York State Police, or Yates County Sheriff Department responsible. My actions and mishaps are accountable to no one but myself. I agree to withdraw from the race if so instructed by a race official. I grant the race organizers the free use of my name, and any photos or videos of me for any use related to the race they see fit. I acknowledge that my entry fee in non-refundable, even if the race is canceled because of an act of nature or man.

* If participant is under 18 then parent or guardian must also sign.

Date: _______________ Signature: ___________________________________

* Parent/Guardian Signature: ___________________________________