THIRD
ANNUAL!!!
SHAMROCK SCURRY
5K Benefit Run/Walk
& 1 Mile Fun Run (12 and Under)
DATE: Saturday, March 18, 2006
TIME: 1 Mile Fun Run: 8:15am; 5K: 8:45am
LOCATION:
(Killearn
Subdivision)
SPONSOR:
Children of Ireland
Group, Inc.
-a 501 (c
)(3) non-profit organization
PROCEEDS BENEFITING: MAKE A WISH FOUNDATION AND
THE CHILDREN OF IRELAND
GROUP, INC.
AWARDS:
BEAUTIFUL
-Awarded to top overall 1st & 2nd male and
female runners!!
-Trophies
to 1st , 2nd
& 3rd male & female runners in
5-year age groups!!
POST RACE EVENTS:
-PANCAKE BREAKFAST FOLLOWING 5K RACE (***NOTE: $3 WITHOUT RACE #)
FURTHER INFO: Terry Ryan: terry@childrenofireland.us
or call (850) 321-9352
Return
entry forms to: PLAY IT AGAIN
SPORTS-1383 Capital
Make
checks payable to: Children of Ireland
Group, Inc. or CIG
(pickup runner packets at PLAY IT AGAIN SPORTS Starting
Wednesday,
March 15th and By 5PM Friday, March 17TH)
PROCEEDS BENEFITING:
-----PLEASE COMPLETE,
TEAR OUT, AND DROP-OFF TO BELOW
LOCATION OR
MAIL TO BELOW ADDRESS----
---------------------------------------------------------------------------------------------------
Please
Circle Applicable entry fee & circle t-shirt size (if wished):
|
|
PRIOR TO MARCH 7TH |
ON OR AFTER MARCH 7TH |
SHIRT |
||||
|
UNDER
18 |
18 & OVER |
UNDER 18 |
18 & OVER |
Circle |
|
||
|
WITH
T-SHIRT |
WITH T-SHIRT |
WITH T-SHIRT |
WITH
T-SHIRT |
Small |
|
||
|
$10 |
$15 |
$15 |
$20 |
Medium |
|
||
|
NO T-SHIRT |
NO T-SHIRT |
NO T-SHIRT |
NO T-SHIRT |
Large |
|
||
|
$5 |
$10 |
$5 |
$10 |
X-Large |
|
||
(PLEASE PRINT
LEGIBLY) QUESTIONS? CALL: 321-9352
Name:__________________________________________________________
Age on 3/18/2006: _______________ Gender:_____Male _____Female
Telephone:_________________________
E-Mail:______________________________________________________
Address:____________________________________________________
City:
How did you hear about
Scurry: ___Fleetfoot
____Chi Omega
__Flyer at other race __Flyer in local store __Other____________
Please Sign the “Release &
Waiver” statement below and drop off w/check to:
PLAY IT AGAIN SPORTS –
OR mail to: The Children Of Ireland Group, Inc.,
An
IRS 501(c)(3) Non-Profit Organization
I know that running a road
race is a potentially hazardous activity. I should not enter and run unless I am
medically able, physically fit and properly trained. I assume any and all risks
associated with this event including but not limited to falls, contact with
other participants, effects of weather, including heat and/or humidity, and
traffic and the conditions of the roads,
all such risks being known and acknowledged by me.
I agree to abide by all
decisions of the race officials relative to my ability to safely complete this
run. I agree to not wear headsets, run with dogs, baby joggers, or strollers
during the race. Knowing these facts and in consideration of your accepting my
entry, I hereby, for myself, my heirs, executors, administrators or anyone else
who might claim on my behalf, covenant not to sue, and waive, release and
discharge all The Children Of Ireland Group, Inc., race officials, volunteers
and all sponsors including their agents, employees, assigns, or anyone acting
on their behalf from any and all claims or liability for death, personal injury
or negligence or carelessness on the part of the persons named in this waiver.
This Release and Waiver extends to all claims of every kind and nature
whatsoever, foreseen or unforeseen, known or unknown. The undersigned grants
full permission to The Children Of Ireland Group
and/or agents authorized by the organization to use any photographs,
videotapes, motion picture or an other record of this for any legitimate
purpose.
Signature (parent if under 18)____________________________________________
Date:__________________________