| 10K Run Fee prior to October 2: $25 ___ 10K Run Fee Race Day: $30 ___ |
| 5K Run/Walk Fee prior to October 2: $20 ___ 5K Run/Walk Fee Race Day: $25 ___ |
| 2K Fun Run Fee to prior to October 2: $15 ___ 2K Fun Run Fee Race Day: $20 ___ |
| Kids Obstacle Course Fee prior to
October 2: $15 ___ (Ages
5 and under) Kids Obstacle Course Fee Race Day: $20 ___ |
| Family Rate: $75 ___ (available only through mail-in registration with this form by September 30) |
Amount Enclosed $______.___ (Check payable to The Montessori
Academy)
I cannot participate but would like to make a donation to this wonderful cause:
Donation Amount Enclosed $______.___
(Check
payable to The Montessori Academy)
Mail this form and your entry fee to:
Fall Frolic •
The Montessori Academy at Edison Lakes
530 • East Day Road •
Mishawaka, IN 46545
If you have questions, please call The Montessori Academy at Edison Lakes, (574)
256-5313.
Waiver/Release
This race will be timed using a Sportag “chip” timing device provided by the
race and Runners Edge Race Timing. I understand it needs to be returned after
the race. I agree that I will pay a $25.00 replacement fee if I do not
return the Sportag.
I know that running in the Fall Frolic 10K/5K, 2K Fun Run and Kids Obstacle Course is a potentially
hazardous activity. I should not enter and run unless I am medically able and
properly trained. I agree to abide by any decision of a race official relative
to my ability to safely complete the run. I assume all risks associated with
running in this race including, but not limited to, falls, contact with other
participants, the effects of the weather, including extreme cold or high heat
and/or humidity, traffic, and the conditions of the road. All such risks being
known and appreciated by me. Having read this waiver and knowing the facts and
in consideration of your accepting my application, I for myself and anyone
entitled to act on my behalf, waive and release The Montessori Academy at Edison
Lakes, its volunteers, race directors and successors from all claims or
liabilities of any kind arising out of my participation in this event even
though that liability may arise out of negligence or carelessness on the part of
the persons named in this waiver. I grant permission to all the foregoing to use
any photographs, motion pictures, recordings, or any other record of this event
for any legitimate purpose. All persons under age 18 years of age must have
written consent of parent/guardian to compete in the above mentioned events. the
undersigned parent/guardian herby consent to the applicants participation and
waive and release rights and claims for damages as is more fully set forth
above.
Signature (parent/guardian if under 18)
_________________________________ Date __________
All children under the age of 12 must be accompanied by an adult.