When:

Sunday August 7, 2011
9:00a.m. Basket Run 5K

Where:

Memorial Park, Memorial Drive, Berlin Heights       

Registration Fee:

$12.00 pre-registration (nonrefundable)
$15.00 day of the race
Pay by check or money order to:                                  
Basket Festival
c/o Basket Festival Committee , P.O. Box 378, Berlin Heights, OH 44814

T-Shirts:

Provided to the First 150 runners registered

Awards:

Plaques to 1st and 2nd overall male/female runners. Trophies to the top 3 in each age group.

Door Prizes:

All 5K finishers will be eligible to win, winners must be present. Prizes include:  Kalahari Resort Water Park Passes, Mayors Trophy for both Women and Men's division, and much More

(Tip): type in the information with your keyboard before printing out this form)

By my signature I attest that I'm physically trained to participate in this event. I have full knowledge of risks involved. I further acknowledge that the race course may contain uneven surface conditions, including but not limited to potholes, curbs, and tree roots which may create a risk. I further acknowledge that at least part of the course is on public roads and that vehicular traffic may be encountered and I accept those risks. I understand that bicycles, skateboards, roller skates, in-line skates, animals and radio headsets are not allowed and I will abide by this guideline. I further acknowledge that weather conditions including heat and humidity may be a risk which I accept. Therefore having read this waiver, and in consideration of the acceptance of my entry, I for myself, my heirs, my representatives, my executors and administrators waive any and all rights and claims for damages I may have against Berlin Heights race sponsors, the village of Berlin Heights and any individual associates with this event and agree to release and will hold them harmless for any and all injuries I may suffer in conjunction with this event.

Name: Sex: M  F Clydesdale
Address:
City State  Zip
Age day of race  T-Shirt Size: M L XL XXL Phone:         

Signature________________________________________        Date_____________
(Parent must also sign below if entrant is under 18 years of age.)

PARENT or GUARDIAN________________________________    Date____________

Male/Female: 12 and UNDER, 13-15, 16-18, 19-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-69, 70+ Clydesdale (190 pounds and over)