2012 5k Run / Walk for Life

Life Choice Care Center logo

Saturday, April 7, 2012

8:00 am Registration & Packet Pick up
9:00 am 5K Race begins

Floral Park

9530 S Parkside Ave, Floral City, Florida
(Approximately 2 miles south of the light in Floral City)

Entry Fee

Register on-line or mail this form with check payable to:
Life Choice Care Center (see contact info below)
$20 Pre-Registered (Must be received by March 31, 2012)
$5 Kids Entry (10 years old and under only)
$25 Race Day Registration

5k Awards

(T-Shirts guaranteed to all pre-registered)
Overall Male Overall Female
Overall Masters 40+ Male Overall Masters 40+ Female
3 awards in 5 year age groups (11 thru 65-up)

Contact

Life Choice Care Center 305 S. Line Avenue Inverness, FL 34452
(352)341-5176   office@lifechoicecarecenter.org

Walk for Life / Diaper Dash Registration Form

* First Name:
Middle Name:
* Last Name:
Participant Address
* Address line 1:
Address line 2:
* City:
* State:
* Postal Code:
* Email Address:
* Phone Number:
* Birthdate:
* Age:
* Gender: Female
Male
* Category: 5K
1 Mile Walk

2012 5K & Walk for Life RELEASE WAIVER; I understand that Entry Fees are Non-Refundable & Non-Transferable. I know that running a road race 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 event including but not limited to: falls, contact with other participants, the effects of weather, including high heat and humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I understand that bicycles, skate boards, baby joggers, roller skates or blades, animals and radio headsets are not allowed in the race and I will abide by these guidelines. Having read this waver and knowing these facts and in consideration of your accepting my entry, I for myself and anyone entitled 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 person named in this waiver. I also agree that I may be examined and treated if necessary during the course of the race by qualified race personnel in the event medical problems of any cause arise. The race officials or qualified personnel have the right to remove me from the race if, in their opinion, I may be suffering from a life threatening condition. I understand that the course is open to behicular traffic and will compete with due care. I agree to return any equipment issued for the event, such as timing chips, or I will pay for their replacement.

I agree to terms above.