1. APRIL 16th
, 2016
6th
Annual Walker Run
5K & 10K Run & 1 Mile Walk & Hero Kid Dash
AGE of participant:
(Please (1) Form per person)
Please Check 5K 10K WALK KID DASH ($10.00 t-shirt incl.)
AdditionalMonetary Donation – Shirt Only
Full Name: __________________________________________
Mailing Address: __________________________________City: _____________________________
State/Province: ______ Zip/Postal _______Phone: (_____) _________
Email: ___________________________________________________________________
COST: Adult $30.00 by April 9th/$35.00 event day.
Students: $10.00 by April 9th. Goodie Bags for all.
Top 3 Male & Female finishers receive trophy.
Ten-year age division awards for men and women (18-29, 30-39, 40-49, through age 70 etc.)
R
EVENT DISCLAIMER: Please review the following waiver and disclaimer.
Exempt any liability from the City of Farmington and the Walker Johns Childhood Cancer Foundation by adding your signature you
accept this waiver and disclaimer. Waiver and Release: By participating in this Event, I assume all risk of injury, illness, damage or
loss to me or my property that might result, including without limitation, any loss or theft of personal property.
Signature of Responsible Party: ______________________ Date: ____________________
Register online at: http://walkerjohns.foundation / Mail: 3276 Old Fredericktown Rd. Farmington, Mo.
63640
Adult - S ___ M ___ L ___ XL ___2XL ____ $2.00) 3XL___
($2.00)
Toddler – Sizes: 2-4 _____ 4-6 ____ 8-10 ____ 10-12 ____1
6.00 Plate Lunch by 12 WEST
Location: Farmington High School #1
Black Knight Drive Farmington, Mo.
Pre Registration 7:30am
Kid Dash 8:30am Event 9:00am