7Th Annual Taking Steps to End Child Abuse

7th Annual Taking Steps to End Child Abuse 5K COLOR RUN/ 1 Mile Walk Saturday, April 29, 2017 In memory of Duncan and Jack Leichtenberg and in celebration of their lives, we invite you to support Children’s Home + Aid and take steps to end child abuse. Challenge your family, friends, or co-workers to a 5K run or 1 mile walk at Fairview Park in Normal. Bring the whole family! Strollers and dogs are welcome too!

Each participant must be registered. For more information, contact Laura Cordero at (309) 834-5294 or [email protected]. Race Day Registration Fees 7thA 9 am Check-In/Registration $35 –Pre Registration nnu al 10 am Balloon Release $35 –Race Day Registration 10:15 am 1 Mile Walk begins Children 12 and under are free! 10:30 am 5K Run begins Awards will be presented Taking Steps to End Child Abuse 5K COLOR RUN /1 Mile Walk

Name: Email: Address: City/State: Zip Code Phone: Age (on 4/29/17):__ Date of Birth: Gender: _____ Male _____Female ____Prefer Not to Identify Event: _____ 5K Run _____1Mile Walk (non-competitive) Adult Shirt Size _____ S _____ M _____ L _____ XL _____ XXL ______$35 Entry Fee (Make checks payable to Children’s Home + Aid and include in memo line “Taking Steps.”) _____ $10 extra T-Shirt Order _____ In addition to the entry fee, I would like to make a donation to Children’s Home + Aid in memory of Duncan & Jack Leichtenberg. _____ I am not able to attend, but would like to make a donation to Children’s Home + Aid in memory of Duncan & Jack Leichtenberg. _____ Total Enclosed In consideration of this entry being accepted, I, for myself, my executor, administrators, and assignees, do hereby waive, release, and discharge all rights for claims and damages I may have against Children’s Home + Aid and all other sponsors, including their directors, officers, and employees, for any injury, sickness or loss to me arising out of or in connection with my participation in Taking Steps to End Child Abuse 5K run/ Walk. I further attest that I am in good health and have sufficiently trained for the completion of this event. Emergency Contact Phone

Signature Date (Parent signature needed if under 18)

Mail registration form and payment to: Children’s Home + Aid, ATTN: Laura Cordero, 403 S. State St., Bloomington, IL 61701