Miles for Matt Foundation
Celebrate Life III 5K Run/Walk
Saturday, June 4, 2016
Half-Mile Kids Fun Run at 8am and 5K follows
Cedar Creek Park
Merrick Road east of Wantagh Avenue, Seaford, NY
Post Race Ceremony, Refreshments
COURSE: 5K (3.1 miles) course inside Cedar Creek Park, 3340 Merrick Road, Seaford AT 8:40 AM; Half-Mile Kids Fun Run (12 and under no t-shirts), medals to all finishers, at 8:00am.
Packet Pick-up: Runner’s Edge, 242 Main Street, Farmingdale Friday June 3 3pm—6:30 pm or Race Day at Cedar Creek Park from 6:45 am—8:15 am
AWARD CATEGORIES: Top 3 overall male and female; Top 3 Finishers Male/Female as follows:
14 & Under; 15-19; 20-24; 25-29; 30-34; 35-39; 40-44; 45-49; 50-54; 55-59; 60-64; 65-69; 70-74; 75-79; 80+
Each Participant must fill out an Entry Form. To register
additional participants, please duplicate this form or visit
www.miles4matt.org for additional forms.
MAIL IN REGISTRATION
Phone: ________________________________ Race Day Age: ________
5K Run/Walk Male Female Special Needs
1/2 mile KIDS FUN RUN
I am unable to participate, however I would like to make a donation of $_________.
ENTRY FEE: (If registered by 5/14/16)
$25 – 5K Run/Walk
$15 – 5K Run/Walk (student – grades 12 & under)
$5 – Kids Fun Run/Walk (ages 12 & under)
LATE & RACE DAY ENTRY FEE: (If registered 5/15/16 – 6/4/16)
$30 – 5K Run/Walk
$20 – 5K Run/Walk (student – grades 12 & under)
T-SHIRTS PROVIDED TO PARTICIPANTS WHILE SUPPLIES LAST!
Please circle t-shirt size:
S M L XL
TOTAL ENCLOSED: $ ______________________________________
MAKE CHECKS PAYABLE TO: MILES FOR MATT FOUNDATION
I hereby waive and release any and all rights and claims I may have against the Miles for Matt Foundation, Nassau County Department of Parks and Recreation, and the race Sponsors for damages which I may have arising out of this event. I am physi-cally fit and have trained for this race. The applicant warrants that “my physical condition has been verified by a licensed medical doctor.” “Further, I hereby grant full permission to any and all of the foregoing to use any pictures, or any record of this event for any purpose whatsoever.”
If signed by a parent, the parent agrees to release and hold the above named organizations and persons harmless of any claims which may be asserted by or on behalf of the entrant. Cedar Creek Park and Miles for Matt Foundation reserves the right to cancel this event in the case of inclement weather for safety concerns. No refunds.
Signature of parent or guardian if under 18 years old DATE
Mail Application to:
Miles for Matt Foundation
Att: Lynn Scarpati
P.O. Box 20117
Huntington Station, NY 11746
Register online at: https://runsignup.com/Race/NY/Seaford/CelebrateLife5K
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