El Molino High School The Shock Run 5k Fundraiser

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1 El Molino High School The Shock Run 5k Fundraiser April 9, :00 am registration, 10:00 am race begins 5k-3.2 miles Benefiting the El Molino Health Tech. Department EVENT DETAILS: We are fundraising to buy an AED/other medical supplies for the El Molino Stadium so please come out and help us give a little piece of mind to our athletes and their parents/guardians. Awards : There will be only 1 race split into divisions. The first finisher will be the overall champion and will be awarded accordingly. First place division runners will also be receiving an award. The divisions are: Adult Male, Adult Female, Student Male, and Student Female. Course Description : Begin at El Molino High School to Green Valley Road and back on the West County & Rodota Trail Bike path. Post Race : Refreshments and snacks with some sponsor booths to peruse until the award ceremony which will take place after all runners have crossed the finish line. REGISTRATION PACKET PICK UP: Any time before April El Molino main office or on the El Molino website (elmolino.org), and El molino Facebook page. EVENT LOCATION PARKING/DIRECTIONS: El Molino High School 7050 Covey Rd. Forestville, CA Parking will be in the student and faculty parking lots. POST RACE: Refreshments: water and snacks

2 PLEASE COMPLETE THE FOLLOWING REGISTRATION PACKET AND DROP OFF OR MAIL IN TO EL MOLINO HIGH SCHOOL WITH A CHECK PAYABLE TO: El Molino High School/EMHS or CASH Mailing Name FIRST NAME LAST NAME Mailing Address STREET ADDRESS CITY STATE Zip DATE OF BIRTH mm/dd/yy / / SEX (CIRCLE ONE) M F RACE ENTERED: 5K SHIRT SIZE (CIRCLE ONE) S M L XL XXL (add $1.50) if size not shown please fill in here ENTRY FEES: $25 POSTMARKED BEFORE 03/27/17 $30 AFTER 03/27/17 $35 RACE DAY 03/09/17 ENTRANTS

3 ***PLEASE NOTE*** NO SHIRT IS GUARANTEED FOR ENTRIES RECEIVED AFTER APRIL 9TH. PLEASE READ, SIGN AND INITIAL THE FOLLOWING TERMS AND CONDITIONS. I know that running [volunteering for] a road race is a potentially hazardous activity, which could cause injury or death. I will not enter and participate unless I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this event, and am in good health, and I am properly trained. I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I assume all risks associated with running in this event, including but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I understand that bicycles, skateboards, roller skates or rollerblades, and headsets are not allowed in the race and I will abide by this guideline. Having read these terms and conditions and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, understand and waive the El Molino Shock Run 5k Health Tech. Dept. Fundraiser, the city of Forestville, CA, El Molino High School, West Sonoma County Union High School District and all sponsors, their representatives and successors 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 persons named in this waiver. INITIAL (parent or guardian required if under 18) Print name of participant Signature of participant Parent/Guardian signature Questions? Call Emma Elliott at (707) , eelli690@wscuhsd.k12.ca.us or Torrey Farmer (707) , tfarmer.ehs@wscuhsd.k12.ca.us

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5 Emergency contacts: 1. Name Relation Phone # 2. Name Relation Phone # 3. Name Relation Phone # (perforate this part) El Molino High School The Shock Run 5k Fundraiser April 9, :00 am registration on the El Molino football field 10:00 am race begins 5k-3.2 miles Benefiting the El Molino Health Tech. Department Parking will be in the student and faculty lots Bring with you on the day of to get your shirt and number. Name Shirt size You will receive your number when you get your shirt on the day of race. Number