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Hustle 4-Health 5K Run/Walk 151 E. Briarcliff Rd., Bolingbrook, IL 60440 April 12, 2014 8:00AM Registration First Name: _________________________ Last Name: _________________________ Address : __________________________ City: ______________________________ State: _____________________________ Zip: _______________________________ Home Phone: _______________________ Cell Phone: _________________________ Email: _____________________________ Gender: Male Female Shirt Size: Small Medium Large X-Large (Shirt sizes will be based on regular men sizes.) Date of Birth: _________________ Age on Race Day: ________ Payment: Make $25.00 check payable to Bolingbrook Christian Health Clinic and mail to the address below by April 2nd, 2014: Hustle 4Health 5k ATTN: Maria Schilder 317 Janes Ave Bolingbrook, IL 60440 A Special thanks to our Sponsor BOLINGBROOK CHRISTIAN HEALTH CENTER BOLINGBROOK CHRISTIAN HEALTH CENTER

A Special thanks to our Hustle 4-Health Sponsor 5K …bolingbrookchristianhealthcenter.com/.../2012/11/hustle4health.pdfin any and all activities connected with the Hustle 4-Health

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Hustle 4-Health 5K Run/Walk

151 E. Briarcliff Rd., Bolingbrook, IL 60440

April 12, 2014 8:00AM

Registration

First Name: _________________________

Last Name: _________________________

Address : __________________________City: ______________________________

State: _____________________________Zip: _______________________________

Home Phone: _______________________

Cell Phone: _________________________

Email: _____________________________

Gender: Male Female

Shirt Size: Small Medium

Large X-Large

(Shirt sizes will be based on regular men sizes.)

Date of Birth: _________________

Age on Race Day: ________

Payment: Make $25.00 check payable to Bolingbrook Christian Health Clinic and mail to the address below by April 2nd, 2014:

Hustle 4Health 5k ATTN: Maria Schilder 317 Janes Ave Bolingbrook, IL 60440

A Special thanks to our Sponsor

BOLINGBROOKCHRISTIAN

HEALTH CENTER

BOLINGBROOKCHRISTIAN

HEALTH CENTER

BOLINGBROOKCHRISTIAN

HEALTH CENTER

BOLINGBROOKCHRISTIAN

HEALTH CENTER

BOLINGBROOKCHRISTIAN

HEALTH CENTER

BOLINGBROOKCHRISTIAN

HEALTH CENTER

BOLINGBROOKCHRISTIAN

HEALTH CENTER

BOLINGBROOKCHRISTIAN

HEALTH CENTER

The 5K Run / WalkApril 12th, 2014

8:00 AM Race Starts

9:15 AM Award Ceremony

New Song Church Front Parking Lot

151 E Briarcliff Rd, Bolingbrook, IL 60440

Course descriptionLine up begins at 7:30 a.m. in the front parking lot of New Song Church in Bolingbrook. The first 2 miles are through the quiet neighborhood. This portion of the race is mainly flat with a little incline at the beginning. The last mile involves running on a park district trail that is paved and hilly.

Award CategoriesOverall male and female winner (not eligible for age division awards)

• 14 & under• 15-19• 20-29• 30-39• 40-49• 50-59• 60 and above

Registration• Online pre-registration, $25 plus

surcharge, closes on 4/9/2014 at 9 AM

• Registration by Mail with a $25 check payment, must be received by 4/11/2014

• On-site Registration, $30 cash or check only, Wed 4/9 4-7 PM; Fri 4/11 4-7 PM, and Sat 4/12 7-7:45 AM

• No refunds on fees due to inclement weather cancellations

Shirt SizesPaid registrants by March 15, 2014 will receive a long sleeve tech wicking running shirt; after that day, while supplies last. Shirt sizes will be based on regular men sizes of the following: S. M, L, XL.

Packet Pick-Up Dates• Wednesday, April 9th 4-7 PM 151

E. Briarcliff, Bolingbrook, IL West door

• Friday, April 10th 4-7 PM 151 E. Briarcliff, Bolingbrook, IL West door

• Day of the race, 7-7:45 AM 151 E. Briarcliff, Bolingbrook, front parking lot

WAIVER

I hereby for myself, my heirs, executors and administration, waive, release and discharge any and all rights and claims for damages, however minor or serious, that I/my child may sustain as a result of participation in any and all activities connected with the Hustle 4-Health 5k Run/Walk against the Bolingbrook Christian Health Center, New Song Evangelical Free Church, 4-H 4 Joy club of Bolingbrook, Will County 4-H Extension, or the Village of Bolingbrook or any sponsors of the event. I assume all risks associated with running/walking in this event, including but not limited to: falls, contact with other participants, the effects of the weather including cold or heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I attest and verify that I have full knowledge of the risks involved and that I/my child am physically fit and sufficiently trained to participate in this running/walking event. I hereby grant my consent to any of the above named parties and their authorized agents to use my/my child’s name and any photographs, video tapes or recordings of my participation in this event for any lawful purposes without compensation to me/my child or my behalf. TERMS • The following are not allowed in the race: animals, bicycles, skateboards, roller skates or roller blades• Baby strollers and baby joggers are allowed in the back with the walkers• Head phones, iPods, mp3 players and similar device are strongly discouraged. Such devices may impair a person’s ability tohear, use proper judgment or detect potential hazards on the course• Participants must be able to finish the course within 1 hour and 15 min

Please sign at the X below if you have read and agree to the waiver and terms:

X __________________________________________________

Date: __________________________

How did you hear about the race?_________________________

____________________________________________________

*PARTICIPANTS UNDER 18 YEARS OLD:Parent/Guardian’s Name:______________________________________________

Date: _____________

Parent/Guardian’s Signature: ____________________________