2017 R Amon R Ocha 5K R Un/W

Race Registration Make a Difference ToR participateaRcaec einR the eR 2017gei gRamonsitsr Rochatarta 5Kit Run/Walk,oinon MaAllMa proceedskek from ea the aD RamonDifif Rochafefre 5Ker Run/Walknecnec goe to To participateTo participate in the in the2016 2016 Ramon Ramon Rocha Rocha 5K Run/Walk,5K Run/Walk, All proceeds from the Ramon Rocha 5K Run/Walk go to return this form with payment by noon Oct. 11 to: TheAll Arc proceeds of Livingston-Wyoming from the Ramon Foundation, Rocha 5K Run/Walk which is gothe to returnreturn this thisform form with with payment payment by noon by noon Oct. Oct. 19 to: 19 to: The Arc of Livingston-Wyoming Foundation, which is the The Arc of L-W • Ramon Rocha Run/Walk Thefundraising Arc of Livingston-Wyoming arm of The Arc of Livingston-Wyoming. Foundation, which is the TheThe Arc Arcof L-W of L-W | Ramon | Ramon Rocha Rocha Run/Walk Run/Walk fundraising arm of The Arc of Livingston-Wyoming. 18 Main Street • Mount Morris, New York 14510 fundraising arm of The Arc of Livingston-Wyoming. 18 Main18 Main Street Street | Mount | Mount Morris, Morris, NY 14510NY 14510 The Arc is the area’s largest primary service provider MakeMake checks checks payable: payable The to: ArcThe ofArc Livingston-Wyoming of Livingston-Wyoming for individuals with intellectual and developmental Make checks payable: The Arc of Livingston-Wyoming The TheArc Arcis the is thearea’s area’s largest largest primary primary To register online, visit www.lwarc.org servicedisabilities. provider for Through individuals its residential, with vocational To register online, visit www.lwarc.org/runwalk.htm service provider for individuals with To register online, visit www.lwarc.org/runwalk.htm intellectualrehabilitation,intellectual and anddevelopmental children’s developmental services, transportation and Entry fees (Select one): disabilities.community servicesThrough programs,its residential, The Arc helps to enhance Entry fees (Select one): disabilities. Through its residential, Entry$20.00 fees by (Select Oct. 11 one): $25.00 on race day vocationalthevocational lives rehabilitation,of more rehabilitation, than 1,100 children's children's community members who P $20.00articipate $20.00 by Oct. forby Oct. free19 19 via $25.00 sponsorships $25.00 on raceon race (detailsday day below*) services, transportation,rely on services and each year. Participate for free via sponsorships; details below services, transportation, and Team entry Participate fees: for free via sponsorships; details below communitycommunity services services programs, programs, The TheArc Arc $17.00 $10.00 $10.00 perMonster Monsterperson Mile Mile (non-compeitive, (non-compeitive, no t-shirt)no t-shirt) helps to enhance the lives of more Team entry fees: helps to enhance the lives of more Team(Teams entry must fees: have four or more people & register by Oct. 11) thanthan 1,000 1,000 community community members members who who $17.00 $17.00 per perperson person rely on services each year. (Teams must have four or more people & register by Oct. 19.) rely on services each year. Name: ____________________________________________ (Teams must have four or more people & register by Oct. 19.) Name:Name: ________________________________________ ________________________________________ Team Name (if applicable): __________________________ TeamEachTeam member name name (ifmust applicable): (if complete applicable): a registration.________________________ ________________________ Submit them together. EachEach member member must must complete complete a registration. a registration. Submit Submit them them together. together. Street Address: _____________________________________ StreetStreet address: address: ________________________________ ________________________________ City,City, State,State, State, Zip: ZIP: ____________________________________ZIP: ________________________________ ________________________________ a a Phone:Phone: ____________________________________________ ______________________________________ ______________________________________ h Email: _______________________________________ h Email:Email: ____________________________________________ _______________________________________ c T-shirtT-shirt size: size: S S M M L L X LX L c T-shirt Size: S M L XL o Sex:Sex: M M F F Age Ageon raceon race day: day: _______________ _______________ o Waiver:Sex: I know M that running F a road Age race ison a potentially race day: hazardous ________________ activity. I should Waiver: I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am properly trained and medically able. I assume all risks not enter and run unless I am properly trained and medically able. I assume all risks associatedWaiver: I knowwith running that running in this aevent road including race is a but potentially not limited hazardous to: falls, activity.contact with I should Nothing is Impossible associated with running in this event including but not limited to: falls, contact with Nothing is Impossible R othernot enter runners, and the run effects unless of I weatheram properly including trained heat and/orand medically humidity, able.traffic I andassume all Nothing is Impossible R yo other runners, the effects of weather including heat and/or humidity, traffic and Costumes Welcome! roadrisks conditions,associated all with such runningrisks being in knownthis event and appreciated including bybut me. not Having limited read to: this falls, Costumes Welcome! road conditions, all such risks being known and appreciated by me. Having read this k waivercontact and with knowing other these runners, facts and the in considerationeffects of of weather your accepting including my entry, heat I, and/or k waiver and knowing these facts and in consideration of your accepting my entry, I, n n l forhumidity, myself andtraffic anyone and to road act onconditions, my behalf, all waive such andrisks release being The known Arc ofand Livingston- appreciated by Costumes Welcome! for myself and anyone to act on my behalf, waive and release The Arc of Livingston- l Wyoming, all volunteers and sponsors, St. Mary's Church, the Village of Geneseo, me. HavingWyoming, read all thisvolunteers waiver and and sponsors, knowing St. these Mary's facts Church, and thein consideration Village of Geneseo, of your their representatives and successors from all claims and liabilities of any kind out of - acceptingtheir representativesmy entry, I, for andmyself successors and anyone from allto actclaims on andmy behalf,liabilities waive of any and kind release out of o o myThe participation Arc of Livingston-Wyoming, in this event before, all during volunteers or after. and sponsors, St. Mary’s Church, Geneseo Trio Sponsor a my participation in this event before, during or after. Geneseo Trio Sponsor a the Village of Geneseo, their representatives and successors from all claims and Edition - liabilities of any kind out of my participation in this event before, during or after. Edition - ______________________________________________ m ______________________________________________ m Signature__________________________________________________Date W Signature Date W Signature Date / a / __________________________________________________________________________________________ a Parent__________________________________________________ or guardian signature (if under 18) Date Parent or guardian signature (if under 18) Date n Parent or guardian signature (if under 18) Date n R R Run or Walk for Free! u Run or Walk Runfor Free! or Walk for Free!* u Ask your family and friends to sponsor your TheThe Arc Arcof Livingston-Wyoming of Livingston-Wyoming Ask Askyour your family family and andfriends friends to sponsor to sponsor your your 6 participation in the Ramon Rocha Run/Walk. If you 18 Main18 Main Street Street 6 participation in the Ramon Rocha Run/Walk. If If you you Mount Morris, NY 14510 get sponsorships of $100 or more, we’ll waive your Mount Morris, NY 14510 .facebook.com/TheArcLivW R get sponsorships of $100 or more, we’ll waive your 1 get sponsorships of $100 or more, we will waive your R Phone: 585.658.2828 1 registration fee! All pledges must be received before Phone: 585.658.2828 Halloween registrationregistration fee! fee! All All pledges pledges must must be be received received before before Halloween the race starts. The person raising the most money Fax:Fax: 585.658.4109 585.658.4109 www.facebook.com/TheArcLivWyo thethe race race starts. starts. The The person person raising raising the mostthe most money money will 0 K www will win a Fitbit Charge HR. For a sponsorship form, www.lwarc.orgwww.lwarc.org 0 K winwill a Fitbit.win a FitbitFor a sponsorshipCharge HR. form, For a visitsponsorship lwarc.org form, or www.facebook.com/TheArcLivWyo visit lwarc.orgcall or Jeff call T. Jeff at T. at 585.658.2828 x128. www.facebook.com/TheArcLivWyo 585.658.2828 x.128. Special Register: 9:00am, Race: 10:00am Rd, Geneseo Avon Church, 4 St. Mary’s visit lwarc.org or call Jeff T. at 585.658.2828 x128. Arc The - Benefits Trio of the Geneseo - Music Costume contest Part T-shirts - Electronic timing Prizes Food 2 5 October 22 Saturday, T-Shirts • Electronic Timing • Prizes • Food • Costume Contest • Part of the Geneseo Trio • Benefits The Arc The • Benefits Trio of the Geneseo • Costume Contest Part • Prizes Food Timing • Electronic T-Shirts Rocha 2017 Ramon 5K Run/Walk Edition Halloween October 14 Saturday, 9:00 am Register: Race: 10:00 am Geneseo, NY Road, Avon Church, 4 St. Mary’s Special

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