CSB Run for the Schools

5K Run / Walk

Saturday July, 31st Windmont Park- Kewanee, Illinois Starting time 8:30 a.m.

*All proceeds to benefit area public schools* (Kewanee, Galva and Neponset)

Registration: (ends July 24^th) All registrations include T-Shirt

· $15.00 under 18yrs of age

· $20.00 over 18yrs of age

· Late registration $25.00 After July 24^th

· Drop off registration form with payment at any of our convenient locations listed above by July 24^th or mail to P.O. Box 78 Galva, IL 61434

· Pickup packet on Friday July 30^th at our Tenney Street office (address listed above). Race day registration and packet pickup 6:30 to 8:00 am on July 31^st.

Course Description: Flat rectangular course with a few small hills

For additional Tim Nimrick or Dave Draminski

Information: 309-854-2811 309-525-5798

tim.nimrick@commstatebank.com dave.draminski@commstatebank.com

5K Age Groups

14 – under 15 – 19 20 – 29 30 – 39 40 – 49 50 – 59

60 – 69 70 – and over

Awards School Team Award

1^st Overall Male and Female finisher 1^st 5 Students from a District to finish as

1^st 40+ Male Overall designated on the form below.

1^st 40+ Female Overall

1^st Student

1^st Faculty/Staff (Listed categories not eligible for age group awards except for team finishers)

Name_______________________________E-Mail___________________________Phone____________________

Address___________________________Date of Birth____________School District _____________________

City_______________________State____Zip_____________Sex______Age_______Entry Fee$_____________

T-Shirt Size (circle one) Adult S M L XL XXL XXXL Additional Donation amount$______________

I know that running/walking a road race is a potentially hazardous activity. I know that I should not enter a run/walk 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 compete in “Run for the School’s” charity run / walk. I assume all risk associated with running this event. I also know that although police protection will be provided, I assume the risk of running / walking in traffic. Having read this waiver and knowing these facts and in consideration of you accepting my application and non-refundable entry fee, I, for my self and anyone entitled to act on my behalf, waive and release Community State Bank, the City of Kewanee, the Kewanee Park District and all other sponsors, officials, volunteers, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the “Run for the School’s” charity run / walk. I grant permission to all of the foregoing to use any photographs, motion pictures, recording, or any other record of the “Run for the School’s” charity run for any legitimate purpose. UNSIGNED ENTRIES WILL BE REJECTED

Date___________Signed_______________________________________

(Parent / Guardian if participant is under age 18)

Emergency Contact: Name________________________ Ph#_________________