Cook-Wissahickon Run for LiteracyMay 20th, 2017 9:00 AM

Walkers Are Welcome!Let’s get all the students out to run or walk!

$10 students $20 adults who register with students

$25 all other adults

Register Onlinecookwissahickonhsa.com/5k-fundraiser

Open Course through theWissahickon/Roxborough neighborhoodStart at Cook-Wissahickon Elementary School

201 East Salaignac St., Philadelphia, PA 19128

Main Sponsor:

Registration Form and Waiver for Cook-Wiss Run for Literacy

This is a fundraising run to support Principal Lowe’s efforts to get all children reading in the school.

By signing this registration form, I agree to the following: In consideration of the acceptance of this entry to the Cook-Wiss 5K Run for Literacy, I waive all claims for myself, my heirs, and assigns, the sponsors, co-operating and coordinating groups and any individual associated with the event and will hold them harmless for any and all injuries or illnesses which may result from my participation. I further state that I am in proper physical condition to participate in this run/walk. I hereby give my permission to Cook-Wissahickon Elementary School Home and School Association and various media outlets to use my picture in any newspaper, broadcast, telecast, electronic media or any other account of this event, without limitation, and without obligation to anyone to compensate me further thereof. I also hereby consent to permit emergency treatment in the event of injury or illness.***This run/walk is on open public streets and sidewalks. You are running at your own risk.***

Participant 1:_______________________________________________________________________________

(Printed Name, Signature, and Age)

Participant 2: _______________________________________________________________________________

(Printed Name, Signature, and Age)

Participant 3: ________________________________________________________________________________

(Printed Name, Signature, and Age)

___________________________________________________________________________________________________________(Name and signature of parent or guardian if under 18) (Date)

________________________________________________________________________________________(Address)

____________________________________________________________________________________________________________ (Email) (Phone)

Total Registration Amount ____________ ($20 for adults who register with student/ $10 ages 18 & under—All other adults $25) T-Shirt Size(s) Kids - Small ___ Medium ___ Large ____

Adult - Small ___ Medium ___ Large ____ X-Large ___ XX-Large ___ XXX-Large

Checks should be made out to Cook-Wissahickon Home and School Association and presented at registration or returned by mail with this form to Cook-Wissahickon HSA, 201

East Salaignac Street, Philadelphia, PA 19128. For questions or additional information please contact our Run/Walk Coordinator at tomalexander06@gmail.com