1st Annual March Mad Dash 5K & 1-mile Run/Walk Race Day Saturday, March 15, 2014

Registration begins at 8:00 a.m. 1 mile fitness walk begins at 9:00 a.m. / 5K starts at 9:30 a.m. Pandora Missionary Church Check one box below: 5K Road Race (3.1 miles) Fitness Run/Walk (1 mile) Select your shirt size. (Adult sizes, Sport-Tek style. Shirts guaranteed for pre-registrants only. Limited quantity available for purchase on race day.) Small Medium Large Extra Large Awards will be presented to the first place overall male and female finishers; as well as the top male and female runners in each age category. Prizes awarded to 5K participants only. Age categories: 19 and under 20-29 30-39 40-49 50-59 60 and over

Entry Fee: $20 per person if registration is received by March 1, 2014; $25 per person from March 1-March 15, 2014. Make checks payable to: Pandora Missionary Church Fellowship Board Mail checks and entry forms to: Pandora Missionary Church Attn: 5K 300 Rocket Ridge Road Pandora, OH 45877 Entry Form (Please print. Only one entry form per person.) Name _____________________________________________________________ Date of Birth ________________ (MM/DD/YY) Age (as of 3/15/14) ______________

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Street Address ___________________________________________________________________________ City___________________________________________________ Daytime Phone (__ _)___________________________

Waiver/Release
By signing, I understand that running and/or walking is a potentially hazardous activity and I should not participate unless I am medically able to do so. I agree to abide by any and all decisions of race officials relating to my ability to safely participate in this run and/or walk. I hereby assume all such risks associated with running and/or walking in this event including, but not limited to, falls, contact with other participants, effects of the weather, broken bones, bruises, cuts, sprains and strains. Having read this waiver, I hereby release Pandora Missionary Church, the village of Pandora, Hilty Memorial Home, Pandora-Gilboa School District, and its employees and volunteers therein, race officials, race sponsors, officers, and any and all additional groups or individuals associated with this race for any injury or illness, including death, that may result directly or indirectly from my participation in this event. I further acknowledge that I am solely responsible, and agree to release, indemnify, and hold harmless above mentioned parties for any and all medical expenses, treatment, liability, damages, claims, costs, or other expenses arising from any bodily or personal injury sustained directly or indirectly through participation in this voluntarily recreational activity. Strollers and wheelchairs are permitted. Skates, skateboards, bicycles, motorized carts, and the like are prohibited on the course. Anything in question will be left to the discretion of race personnel and their decision will be final. I grant permission to all the forgoing to use any photographs, motion pictures, video tape recordings or any record of this event for legitimate purposes.

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Signature of Participant: ___________________________________________________________Date: _____________ Parent/Guardian Signature:_________________________________________________________Date: _____________ (If participant is under 18) *If participant is under 18, both the parent/guardian AND the participant must sign this form.