Please fill out this registration form and send it and your registration fee to: Alicia Stradley,

158 Montrose Ave, Buffalo NY 14214

Name_____________________________________________________
Address____________________________________________________
City_____________________________ State_____ Zip______________
Phone (___)_______________ Email_____________________
Age on Race Day____________ Gender (circle one) Male Female
Registering for (circle one) T-shirt Size
5k Kids Fun Run Ys Ym YL YXL S M L XL XXL
I understand that running a trail race is a potentially hazardous activity. I should not enter and run unless I am medically
able & properly trained. I agree to abide by the decision of the race officials relative to my ability to safely complete the
event. I assume all risks associated with running/walking this event including, but not limited to, falls, contact with other
runners, the effects of the weather, & the conditions of the course, all such risks being known & appreciated by me. I
grant permission to the organizing groups to use any photograph, motion pictures or recordings of my taking part in this
event for any legitimate purpose.
Having read this waiver acknowledging these facts & in consideration of you accepting my entry, I for myself, &
everyone entitled to act on my behalf, waive and release Camp Cherith of WNY, volunteers & any and all race sponsors
from any claims or liabilities of any kind arising out of my participation in this event. I understand that all entry fees are
nonrefundable.
I have read this waiver & certify my compliance & agreement with its content with my signature.
Runner Signature: Parent/ Guardian Signature (if under 18)
______________________________________ ________________________________________________
Registration for Camp Cherith 5K and Fun Run
Saturday, August 30
th
, 2014
Race begins at 11:00am

Located at Camp Cherith WNY
9534 Short Tract Rd
Hunt NY 14846

Pre-registration fee: $20 (By Aug 23) Checks made payable to:
Day of registration fee: $25 Camp Cherith WNY
Kids Fun Run: $10