Iroquois County Historical Society Old Courthouse Museum
(815) 432-2215
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Krypt Kicker 5K Run/Walk
Sunday, October 2, 2016
7 A.M. registration
8 A.M. start time
WHERE
Old Courthouse Museum
103 W. Cherry St.
Watseka, IL 60970
The 5K is a timed event,
placing winners in each age group.
Age groups are as follows:
6-12, 13-19, 20-19, 30-39, 40-49, 50-59, 60+
No T-shirt guaranteed for entries made after Sept. 15th.
This is a rain or shine event.
YOU MAY EITHER REGISTER WITH THE FORM ON THE RIGHT OR YOU MAY PRINT THE REGISTRATION FORM
HERE
Register
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
Birthdate
*
Use form mm/dd/yyyy
Emergency Contact Name
*
First
Last
This person will be contacted in the case of an emergency during the race.
Emergency Contact Phone Number
*
Registration Type
*
5 and younger, no T-shirt: Fee $5
6-12 years: Fee $20, after Sept. 15th, $25
13-65 years: Fee $25, after Sept. 15th, $30
66-Plus years: Fee $20, after Sept. 15th, $25
After clicking PAY when you have completed the form, please select the payment option correlating to your selection in this field on the next page.
Shirt Size
*
S
M
L
XL
XXL
N/A
Terms and Conditions/Release of Liability
I know that running or walking a road race is potentially dangerous activity. I realize I should not enter and 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 complete the run. I assume all risks associated with running or walking in this event including, but not limited to, contact with other participants; the effects of the weather, including high heat and/or humidity; traffic and the conditions of the road; all such risks being known and appreciated by me or my parent. Having read this waiver and knowing these facts and consideration of your accepting my entry, I for myself, and anyone on my behalf, waive and release Iroquois County Historical Society, the Old Courthouse Museum, the Watseka American Legion and Park, the 5K run/walk committee, the city of Watseka, all race sponsors, supporters and officials, their representatives and successors from all claims of liabilities of any kind arising out of this event for any legitimate purpose.
By checking this box, I certify that I have read, understood, and accept the terms and conditions stated above.
*
I agree
Pay
