2008 Fall Frolic Registration: Print and Mail with Entry Fee

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

T-Shirt Size: T-shirts are guaranteed for those who register by (date TBA). 10K/5K participants will receive long-sleeved T-shirts. Kids Fun Run participants will receive short-sleeved T-shirts.
    Adult T-Shirt Size: Small ___   Medium ___   Large ___   X-Large ___  
    Youth T-Shirt Size: Small ___   Medium ___   Large ___  

Event: 10K Run ___   5K Run ___   5K Walk ___ Kids Fun Run ___  

Nonrefundable registration fees:

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

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 and Kids Fun Run 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.
If you have questions, please call The Montessori Academy at Edison Lakes, (574) 256-5313.