Sunday, April 26, 2015 at 2:00 p.m.
Race Day Registration Begins at 12:30 p.m.
Ontario High School Track, 467 Shelby Ontario Road, Mansfield, Ohio
Registration Fee $20.00
Proceeds benefit the OhioHealth MedCentral Diabetes Education Scholarship Fund
Registration forms can be completed below or by downloading the form here.
MedCentral Health System is hereby authorized to make the following deductions from my wages. In the event I terminate employment with MedCentral Health System before this balance is paid, I understand that it will be deducted from my final paycheck.
Age on Race Day:
5-digit employee id #:
Current Mailing Address:
Please select one: 5K Run5K Walk1 Mile Walk
Shirt Size (guaranteed with pre-registration by April 15, 2015): SMLXLXXL
The $20 Registration fee will be deducted in 1 Pay - Effective date is the next pay period
I know that running or walking a road race is a potentially hazardous activity. I should not enter and participate unless I am medically able and properly trained. I agree to abide by any decisions of a race official relative to my ability to safely complete the race. 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, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I for myself, and anyone entitled to act on my behalf, waive and release OhioHealth MedCentral Endocrinology and all persons, sponsors and entities from all claims and 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. Parents or Legal guardian must sign release if participants are under the age of 18 years old on the date of the race. Entry fees are non-refundable.
Employee Signature (typed):