6/12/10 Hands For Hope, Patchogue, NY

PATCHOGUE VILLAGE-SHORE FRONT PARK-PAVILLIAN, Smith Street, Patchogue

Start Time

9:00 a.m.

Start Location:

Shore Front Park Pavillian

Fees:

Student Rate: $15.00

Adult/Nonstudent Rate: $25.00

Register on-line at

Fun Stuff:

*Music by Oregon’s own JP Experience under the Pavillian

Timing, Race day logistics & Finish Line by Island Timing

Waiver and Release:

I acknowledge that participating in a 5K race can be potentially hazardous activity.  I am medically able and properly trained to participate.  I assume all risks associated with running/walking in this event.  In consideration of the acceptance I hereby waive on behalf of my heirs, executors and assigns, all claims of any nature arising from my participation in the HANDS FOR HOPE 5k Race/Walk for Charity, and do hereby release THE HANDS FOR HOPE Organization, Patchogue-Medford Schools, their workers, officials and volunteers from any claims or liabilities of any kind arising from my participation in this event.  I agree to abide by all the rules to participate.

Signature___________________________________

Parent Signature ____________________________

(required of entrants under 18)

 Date:______________________________________________

**Register ONLINE at: Hands for Hope on active.com

If you are a student Middle School:				Grade
r	Oregon							$15.00
r	Saxton							$15.00
r	South Ocean							$15.00
	Adult/Non student							$25.00
	Circle: Male or Female Age on day of Race__________
Name
Address
Phone
E-mail
MAKE CHECKS PAYABLE TO : OREGON MIDDLE SCHOOL Mail to: Oregon Middle School 109 Oregon Avenue Medford, N Y 11763