Online Registration

3rd ANNUAL MOTHER’S DAY
5K RUN & WALK
  



 

WOODSIDE CEMETERY AND ARBORETUM
MIDDLETOWN, OH
SUNDAY, MAY 13, 2012 – 8:30 AM

Online Registration Is Closed
   

Proceeds benefit Middletown Hospice Care.

LOCATION: Fairly flat course on paved trails through beautiful historic cemetery and arboretum (over 100 years old). For safety reasons, please do not bring pets. (Strollers are permitted if starting behind runners and faster walkers).

Directions to Woodside Cemetery: 1401 Woodside Blvd, Middletown located at intersection of State Rt. 4 and 14th Ave., approx. 3 miles north of SR63 west, I75 exit #29, or less than 1 mile south of downtown Middletown on Rt. 4. (Access from Middletown exit #32, SR122.)

ENTRY FEES: Pre-Registered (by April 28th for shirt, May 5th w/o shirt): $18.00 includes t-shirt, $13 without shirt. Race Day: $20.00 with a shirt as long as supplies last, $15 without shirt. Goody bags to first 100 registered. Check-in and race day registration begin at 7:30 AM. Results will be posted on our website, www.hospicecareofmiddletown.com

CONTACT: Kathy Gough 513-423-7496

AWARDS RUNNERS: Overall Male/Female, Top 3 Male/Female in age groups 12 and under, 13-19, 20-24, through 70-75, then 75+ WALKERS: (if you plan to run any of the course, you must sign up as a runner.) Top 3 each male and female. Special gift for mothers walking or running with their sons or daughters – note below.

POST-RACE: Refreshments and door prizes (must be present to win).
 

Mail In Registration Form
     

Please Enter Participants Information and click below to proceed to a secure credit card processing page. To register more than one participant select the "Add Additional Registration" option after submitting each registration or just click on the "Back Button" in Your Browser to return to this page. A processing fee of $1.25 will be added to the registration.
   
Middletown Hospice Care 5K
   
            Last Name:

            First Name:

                   Gender:

Age On Event Day:

                                 Run
                                 Walk

                  Address:


                         City:


                       State:


                 Zip Code:


                     Phone:


                      Email:


         Date Of Birth: MM/DD/YYYY

       

        In Memory Of: Please note if you are walking or running in memory of a special person:


    Son Or Daughter: Are you a mother walking or running with a son or daughter?

Waiver of Liability: I, intending to be legally bound, for myself, my heirs, next of kin, executors, and administrators, voluntarily assume all risks of accident or injury and release and forever discharge, indemnify and hold harmless Hospice Care of Middletown, Woodside Cemetery, the City of Middletown, officers, sponsors, and agents (collectively the "Released Parties"), from any and all liability for personal injury or property damage of any kind sustained during the Hospice 2011 5k run & walk, whether such personal injury or property damage is caused by the gross negligence or carelessness of the Released Parties. I have full knowledge of the risks involved and attest that I am physically fit and sufficiently trained to participate in the Athletic Event. I grant permission to all foregoing to use any photographs, motion pictures, recordings or any other record of this event for any legal purpose. Please: NO ROLLERBLADES, SKATES, DOGS, OR HEADPHONES – IF WALKING WITH BABY STROLLERS, PLEASE START IN BACK.

                  Waiver:


               Signature: Required For All Participants
(Parent's signature is required if participant is under 18 years of age)

 

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