2010 Fall Frolic Registration: Print a copy for each individual registering.
sign the release and Mail with Entry Fee to the montessori academy at edison lakes.

Name ________________________________________________________________________
Street/City/Zip Code_____________________________________________________________
Phone______________________ Email_____________________________________________
How did you hear about us? ______________________________________________________
DOB _____/_____/_____      Age (on Race Day) _____      Sex _____

T-shirts are guaranteed for those who register by September 1. 10K/5K participants will receive
short-sleeved T-shirts. 2K Fun Run and Kids Obstacle Course participants will also receive short-sleeved T-shirts.

Select T-Shirt Size:
Adult T-Shirt Size: Small ___   Medium ___   Large ___   X-Large ___  
Youth T-Shirt Size: Small ___   Medium ___   Large ___  

Event: 10K Run ___    5K Run ___    5K Walk ___    2K Fun Run ___    Kids Obstacle Course ___

 Nonrefundable registration fees:
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.