9:00 AM I, the undersigned, intending to be legally bound for myself, my heirs, executors, administrators, Lehigh Parkway and assigns, hereby waive and release any and all Allentown, PA rights and claims for damages I may now or hereafter have against the EPDSC and their respective employees for any and all damages or 100% of proceeds will benefit the Eastern injuries which may be sustained by me or my PA Down Syndrome Center family arising out of my participation in the The Eastern Pennsylvania Down Syndrome Center is above activity. dedicated to the physical and mental well-being of ALL persons with Down syndrome and their families. Our mission is to equip families and individuals influenced by Down syndrome with the latest medical advancement, social, emotional and educational I have been informed that the photograph(s) support in order to maximize each individual’s taken with the potential. http://www.epdsc.net ______may Medical Services be used for marketing or other purposes. I Clinical services using a preventive approach are understand that any information obtained during available. These services include: https://www.facebook.com/groups/26613510 this inquiry and identified with me will remain • Comprehensive medical assessments for infants, 3173/ confidential. I also understand that the children and adolescents by one of our physicians. photograph(s) may be used in a presentation, but • Referral of patients to specialists who have an no names or places of employment will be interest in meeting the needs of individuals with referred to in the final presentation. The Down syndrome photograph(s) will become the property of the • Evaluation by our developmental occupational Sponsorship EPDSC where they may be used for future therapist purposes. • Collaboration between our medical staff and the D P G S B F patient’s primary care physician i l o i r r Family Support a a l l o i I understand my participation is strictly voluntary m t d v n e and that I will not receive compensation, • Provides information about Down syndrome to new o i e z n monetary or otherwise, for my participation. families n n r e d • d u Assists families in locating medical, educational, Sponsorship Levels m recreational and social services ______& Benefits $ $ $ $ $ $ • Connects families that have similar medical and 1 7 5 2 1 2 Signature , 5 0 5 0 5 educational needs 5 0 0 0 0 ______• Provides networking opportunities for families 0 m through our annual social events 0 i Date n Recognition in EPDSC For further information about the EPDSC or the 3.21 newsletter Run for Down Syndrome, please contact us at: Link and logo on EPDSC Center: 610-402-0184 * 610-402-0187 (fax) & Race websites www.epdsc.net Logo on Race t-shirts

Recognition on stage Saturday April 15, 2017 during opening ceremonies Recognition & logo in Prizes will be awarded for top 3 in overall, E-mail: print & broadcast media age group, and individuals with Down Table space at the race syndrome. Link, logo, & editorial Shirt Size: □S □M □L □XL copy on EPDSC & Race Course map can be found online at websites www.epdsc.net/special-events/3-21-run-for- Emergency Contact Name:______Primary sponsor identification on all Race down-syndrome Emergency Contact Phone:______print & media Large & prominently Race Day Registration Fees displayed logo on Race t- 8:00 AM Onsite Registration $20.00 Until March 4, 2017 $____ shirt $25.00 March 5 – April 13, 2017 $____ Mail sponsorship information to… 9:00 AM 3.21 Mile Run/Walk 10:30 AM Awards Ceremony $30.00 Day of Race $____ **Registration includes t-shirt (before EPDSC April 2), refreshments, prizes. 6900 Hamilton Blvd. Timing & Registration Provided By: **Submit completed registration form along P.O. Box 60 with check(s) made payable to: Trexlertown, PA 18089 EPDSC 6900 Hamilton Blvd. P.O. Box 60 Questions? Trexlertown, PA 18089

Contact: Wendy Carney Online Registration at: [email protected] www. brynmawrrunning co.com (click on events) Race Information Registration Form The 4th Annual 3.21 Run for Down Syndrome will occur at the Lehigh Parkway □ Run/Walk (by the Fish Hatchery) in Allentown, PA. The 3.21 mile distance symbolizes the 3 Name: copies of the 21st chromosome that causes Down syndrome. Address: Register early for the best deal! $20 until March 4, $25 March 5 - April 13, $30 race day. T-shirts will be given to all participants City: St: who register by April 1, 2017. T-shirts will be available while supplies last for registration after April 1, 2017. Zip:______Phone ______Age: ___ Gender: _____