OxBow Tower Run Entry Form

Proceeds:  The OxBow Tower 5K Run/Walk and 1 Mile Elementary Cross-Country Challenge is hosted by the Two Rivers Running Club in conjunction with the Elkhart County Parks Department.  All proceeds from this run/walk will be used to help rebuild the tower at OxBow County Park that was burned down on July 27, 2010.

When:  Sunday, November 4, 2012 - Race starts at 2:00pm (1 Mile) and 2:30pm (5K run/walk)
           Packet Pick-up/race day registration 12:45pm - 1:45pm at the Fisherman's Shelter

Where:  OxBow County Park - Goshen, In

Description:  The 5K and 1 Mile will be chip timed and run over the high school cross-country course.  The 1 Mile Elementary Cross-Country Challenge is open to students from 2nd-6th grade although students that are a minimum of 5 years old may participate but will compete in the 2nd grade division.  ***No parents/adults allowed on the course during the one mile event.***

Registration:  5K Run/Walk:                          $20.00 pre-registration - postmarked by October 17, 2012
                                                                  $25.00 late registration/race day registration

                    1 Mile Elementary Challenge:    $12.00 pre-registration - postmarked by October 17, 2012
                                                                  $15.00 late registration/race day registration

***Drawstring backpacks guaranteed to all pre-registered runners & walkers...while supplies last for late and race day entries***

Awards:  5K Run:  Top 3 Overall - Male & Female    Top 3 in each age group - Male & Female
                            Age groups:  14 & under, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60+
                            No awards will be given for the 5K walk
              1 Mile:    Top 3 Overall - Male & Female    Top 3 in each grade division - Male & Female
                            2nd grade, 3rd grade, 4th grade, 5th grade, 6th grade

Donations:  If you are unable to participate in this event but would like to make a donation to this cause, please fill out the appropriate information below.  Your donation is tax deductible.  Thank you.

Last name:  ____________________________  First name: _____________________________

Address:________________________________ City/State/Zip:___________________________

Email:__________________________________ Phone:_________________ Age:________ Sex:________

5K Run:______  5K Walk:______  1 Mile Elementary Challenge:______  Grade:______

Amount enclosed:____________    Donation amount:____________

Waiver:(must be signed)
In consideration of this entry being accepted, I, for myself, my heirs, executors, assigns, and administrators, waive and release any ans all claims for damages, I may have against, any and all sponsors, representatives, organizers, Two Rivers Running Club, RRCA, and the Elkhart County Parks Department.  I attest and verify that I am physically fit and have sufficiently trained for the competition of this event.  I have read and understand the form I am signing.

Signature:_____________________________________  Date:______________
(of parent or guardian if under 18 years of age)

Make checks payable to:  Elkhart County Parks Department, 211 W. Lincoln Avenue, Goshen, IN 46526

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