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Falling Footsteps Application .pdf

Original filename: Falling Footsteps Application.pdf
Author: K Family

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We Will Have:
Glasses to Registrants
Prizes for Age Groups

RSCC Falling Footsteps

Falling Footsteps
The Richfield Springs Community Center cordially invites
you to participate in the annual Falling Footsteps 5K Minimudder. Part of the proceeds will benefit the Youth
Basketball Hoop Fund.

Route 20 Series:

Go to


Name:__________________ Age ______
* Sex: M F (Circle One) (on 9/13/15)
Amount _______
e-mail ____________________________
In consideration of acceptance of this
application, I, the undersigned, intending to
be legally bound, hereby, for myself, my
heirs, executors, administrators, and assigns
waive any and all rights and claims for
damages I may have against the Richfield
Springs Community Center, their
representatives and successors for any and
all injuries suffered by me at the races to be
held in Richfield Springs, on Sept. 13, 2015.
I verify that I am physically fit and have
trained sufficiently for the competition.
Signature __________________________
Parent Signature____________________
Please make Checks payable to: “RSCC”
Mail in with Applications to:

Bill Kosina: 1434 Cty Hwy 25 Richfield Springs, NY 13439
Questions: 315-749-3286 jabkos@verizon.net

The Richfield Springs
Community Center Run
Sept. 13, 2015

TIME: 1:00 – 1:45 on Race Day
PLACE: Richfield Springs Sportsmen’s
Club, Route 25 Richfield Springs

Start Time:
@ 2:00 PM

Pre-registration postmarked on or before (Sept. 5, 2015)
(All ages)
Day of race:
(All ages)

Part of the Route 20 Series

Proceeds benefit:
The Richfield Springs
Community Center

Falling Footsteps Application.pdf - page 1/2
Falling Footsteps Application.pdf - page 2/2

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