3rd ANNUAL

JWA Spring Classic

5K Run/1 Mile Fun Walk
Saturday, April 24, 2010 at 9am
Faries Park Golf Course Pavillon Decatur, IL

Registration & Information:

• Packet Pick-up and Registration:
• 8:00 – 8:45 on Race Day at Clubhouse
• Post-race refreshments and awards for runners
• Awards at approximately 10:00am.
• No pets please.

Race Course
Race starts in Fairies Park Golf Course at the Club House on the roadway. Out and back course past
the old Gun Club, up and down rolling hills race course through the old scenic Faries Park Golf
Course.

Proceeds
Proceeds will enable JWA to provide needed funds for deserving community projects. For more
information about JWA community projects, visit our website at
www.juniorwelfare.org

Entry Fees and Contact Information

• $20 registration fee - make checks payable to: “Junior Welfare Association”
o Long sleeve t-shirt to first 250 pre-registered entries
• If questions, contact Gretchen Feiertag (217)972-2686
• Mail to: “Junior Welfare Association” Attn: Gretchen Feiertag 4530 E.Lakewood Ave. Decatur, IL
62526

Entry Form & Waiver

11 and
______________________________________ under 5K Run 1 Mile Walk T-Shirt
Last Name First Name 14-16 S

14-16 M
___________________________________
17-19 L
Street Address
20-24 XL
___________________________________ 25-29 XXL
City State Zip 30-34

35-39
___________________________________
40-44
Email
45-49
___________________________________ 50 and up
How you heard about race □ Male □ Female

_____________________________
Signature (Guardian if Under 18)
_____________________________
Date
Waiver: Please Read carefully and sign. For and in consideration of acceptance of my entry in
the above race activity I, for myself, my executors, administrators, heirs and assigns, or as the
parent or guardian of the participant if a minor under the age of eighteen (18),do hereby
release and discharge the Junior Welfare Association, its officers, directors, agents and
members and the City of Decatur, its officials, officers, employees, agents and employees and
all Race Sponsors and volunteers for any and all injuries suffered by me or the minor
participating at this event. I recognize and acknowledge that this is a physical activity and
recognize and acknowledge the risks involved, including, but not limited to, the possibility of
death. I certify that I, or the minor participating, have trained for this race at the above
distance and weather conditions and am physically fit for the race entered. I also understand
that my child/ward or I may be photographed or videotaped while participating. I give
permission for photos and videotapes of my child/ward or me to be used to promote Junior
Welfare Association. Such photos and videotapes will remain the property of Junior Welfare
Association.