Run Your Ashes Off Form - Delphos St. John the Evangelist Parish

When?
Wednesday, February 18th
Registration: 4:30 – 5:30PM
Prayer Service: 5:30
Race Start: 5:45
Where?
Delphos St. John’s Annex
722 S Jefferson St.
Delphos, OH 45833
Cost?
Free Will Donation
Suggested $10 5K or $25 5K with long sleeve wicking shirt Forms due Feb. 9 to guarantee shirt by race day
Proceeds go to St. Vincent DePaul to help those in need in the Delphos community.
Each participant must fill out his or her own application. If paying for multiple people please make a note.
First Name:__________________ Last Name: _____________________ Phone:_______
Suggested donation to run: $10 or with a shirt: $25
Payment Method: Cash or Check (Please make checks payable to Delphos St. John Church) Shirt?
Yes / No
If Yes, circle size: Small Medium Large X-Large
Optional: Do you want your time scored? Yes / No
Gender: M / F
Date of Birth_______________ Home Town___________________
E-mail (for results):__________________________ If scored you need to wear your Bib#
Run your Ashes Off 5K
Waiver & Release from Liability
In consideration for my participation in the Run Your Ashes Off 5K, I for myself and any or all of my representative, do hereby release
and hold harmless all race sponsors, officials, organizers, and volunteers from any claims, including negligence, liabilities, loss,
damage, and expense whatsoever, including legal fees, which may arise out of my participation in the race, including pre and post-race
activities. I also agree to abide by any and all of the rules for this walk/run, whether written or verbal. I further grant permission the use
of my name, photographs, videotapes or recording of my participation in the event for any deemed reasonable purpose.
Signature_____________________________________ Date_________________
Please turn all forms to Delphos St. John’s Ministry Center. Students of St. John’s may turn in forms to
school offices. For questions: 419-233-1600 jbockey@delphosstjohns.org
Last update: 2/3/15