2012 5k Run / Walk for Life

Life Choice Care Center logo

What:

5k Timed Event, Certified Course

When: Saturday, April 7, 2012

7:00 am 5K Run Registration
8:00 am 5K Race begins
8:00 am Walk Registration & Packet Pick up
9:00 am Walk begins

Where: Floral Park

9530 S Parkside Ave, Floral City, Florida
(Approximately 2 miles south of the light in Floral City)
The 5k course starts at Floral Park heading east through a rural horse community. The one mile walk is in Floral Park.
See the Certified Course Map for 5K.

Entry Fee

Register on-line or mail this form with check payable to:
Life Choice Care Center (see contact info below)
5k Racers
$20 Pre-Registered (Must be received by March 31, 2012)
$25 Race Day Registration
Kids Fun Run
FREE (10 years old and under only)
Walkers
Sponsored Walkers Download the Sponsor Form

5k Awards

(T-Shirts guaranteed to all pre-registered)
Overall Male / Overall Female
Overall Masters 40+ Male / Overall Masters 40+ Female
3 awards in 5 year age groups (10 years and under and 11 thru 65-up)

Contact

Life Choice Care Center 305 S. Line Avenue Inverness, FL 34452
(352)341-5176   office@lifechoicecarecenter.org

2012 5k Run / Kids Fun Run / Walk for Life Registration Form

* First Name:
Middle Name:
* Last Name:
Participant Address
* Address line 1:
Address line 2:
* City:
* State:
* Postal Code:
* Email Address:
* Phone Number:
* Birthdate:
* Age:
* Gender: Female
Male
* Category: 5K
Kids Fun Run
1 Mile Walk
T-shirt size:

2012 5K, Kids Fun Run & Walk for Life RELEASE WAIVER; I understand that Entry Fees are Non-Refundable & Non-Transferable. I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event including but not limited to: falls, contact with other participants, the effects of weather, including high heat and humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I understand that bicycles, skate boards, baby joggers, roller skates or blades, animals and radio headsets are not allowed in the race and I will abide by these guidelines. Having read this waver and knowing these facts and in consideration of your accepting my entry, I for myself and anyone entitled from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the person named in this waiver. Life Choice Care Center, DRC Sports, event sponsors, City of Floral City and Citrus County are not responsible for any injuries. I also agree that I may be examined and treated if necessary during the course of the race by qualified race personnel in the event medical problems of any cause arise. The race officials or qualified personnel have the right to remove me from the race if, in their opinion, I may be suffering from a life threatening condition. I understand that the course is open to vehicular traffic and will compete with due care. I agree to return any equipment issued for the event, such as timing chips, or I will pay for their replacement.

I agree to the terms listed above.