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Christmas-Themed 5K Run & 1-Mile Walk Race registration form Online registration: (ends midnight July 21, 2021) Run information: (check event entered) www.kidspeace5k.org m5K run m1-mile walk -OR- www.pretzelcitysports.com Registration cost for 5k & 1 Mile Walk: Registration by mail: $20 if postmarked by July 10, 2021 KidsPeace Jingle in July (includes guaranteed shirt) c/o Pretzel City Sports $25 after July 10, 2021 112 W. 36th St. Reading, PA 19606 (Shirts available while supplies lasts) (Make checks payable to “KidsPeace”) $18 when shirts are gone Course: A Benefit for Kids in Foster Care Shirt size: mS mM mL mXL mXXL Shaded, mostly flat cinder path, measured and professionally timed by Pretzel City Sports. *Rain or shine event* Christmas-themed Race packet pickup: Runner’s information: Fri., July 23, 2021 5K Run &1-Mile Walk 1-3p.m. @ Gring’s Mill Barn Name_______________________________________ On the scenic Gring’s Mill trails Race day, Sat., July 24, 2021 mMale mFemale DOB_____________________ 7-8:15a.m. @ Gring’s Mill Barn Awards, costume contest, raffle & more! Age on Race Day _____________________________ 5K Awards: Sat., July 24, 2021 Address _____________________________________ 1st & 2nd male & female overall 1st, 2nd & 3rd age groups: 14 & under, 15-19, Race-day registration: 7a.m. City ________________________________________ 20-29, 30-39, 40-49, 50-59, and 60+ State________________ Zip ____________________ Fun Awards: 5K begins: 8:30 a.m. Phone ______________________________________ Best family/group theme and most original/ Walk begins: 8:35 a.m. creative Alt. Number __________________________________ *Rain or Shine* Email________________________________________ Donations: Christmas toy drive gift donations can be dropped Gring’s Mill (Waiver: in consideration of the acceptance of my entry, I, for myself, my execu- off during packet pickup or on race day. tors, administrators and assignees, hereby release and discharge KidsPeace, 2083 Tulpehocken Road and all sponsors, volunteers and associates of all claims or damages, demands, Raffle: Wyomissing, PA 19610 actions whatsoever in any manner arising out of my participation in said athletic To take place during event with items donated by event. I attest and verify that I have full knowledge of the risks involved in this (Near Penn State Berks Campus) event and I am physically fit and sufficiently trained to participate in this event. I local businesses. agree that participation in this event allows KidsPeace the use of my photograph for future event promotions, including all forms of media, electronic and written.) Contact KidsPeace at 610-921-0130 or [email protected]. Signature ____________________________________ KidsPeace is accredited by The Joint Commission in Georgia, North Carolina and Pennsylvania. KidsPeace does not discriminate in regard to admissions in terms of sex, race, creed, color, national Date________________________________________ origin, LEP (Limited English Proficiency), religious beliefs, disabilities or handicapping conditions. KidsPeace is a drug-free workplace. We respect our clients’ privacy. The model(s) represented in this (Parent’s signature if under 18 years old) publication is(are) for illustrative purposes only and in no way represent or endorse KidsPeace. © 2021 KidsPeace other than stock photography. 005-0057 Note to participants and spectators: Foster parent requirements in accordance with COVID-19 guidelines, all • 21 years of age All race proceeds benefit attendees will be expected to maintain social • Background free of violent or abusive crimes distancing during the event. In addition, • Experience with children KidsPeace Foster Care participants will be required to wear a mask • Good physical health and Community Programs or face covering at the start and finish of • Earned income to meet current home’s expenses the course, and whenever they are in any • Adequate space for a child (no walk- in Reading. building on the site. through rooms) • Home and auto insurance • Safe physical environment • Open-minded, tolerant, motivated and flexible/available schedule Please bring new, unwrapped gifts KidsPeace Foster Care and Community Programs with you to packet pickup or on race offices are located in Georgia, Indiana, Maine, day. Toys received during the toy Maryland, New York, North Carolina, Pennsylvania, drive will go directly to children from and Virginia. the KidsPeace Foster care program in Reading during the holiday season. For information about becoming a foster parent… please call our main number at 800-25-PEACE (800-257-3223) or the Reading office at 610-921-0130..
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