June 13 (Saturday) 8am

North Brookfield Youth Center 3rd Annual 5K/10K/Road Race/Walk.

5K Loop - for runners who prefer a shorter distance and for walkers
Saturday, June 13, 2009 at 10:00 am

• Race begins behind the North Brookfield High School and courses through scenic North Brookfield around                                                                                           Doane's Pond and Horse Pond. An adult must accompany children running this course.
• A portion of the loop, when leaving the school and when winding around the ponds, is a trail run/walk.
• Entry Fee: $20.00; $10.00 for children age 13 and under
• Adult registrations received by May 29, 2009 will receive a T-shirt.
For children registered by May 29, 2009 please include an additional $5 if you would like a T-shirt.
• Registration begins at 8:30 am and ends at 9:30 am on June 13th.
• Make checks payable to: North Brookfield Youth Center
• Mail to: North Brookfield Youth Center (Attn: Marty Toomey/Race) P.O. Box 86, North Brookfield, MA 01535 

• Prizes will be awarded to the overall first place male and female finishers in the 5K and the 10K divisions,                                                                                                as well as the top finishers in each category.
• All proceeds will benefit the North Brookfield Youth Center.

For more information, contact Marty Toomey, 774-200-0938/ MToomey_NBYC@charter.net

Name___________________________________________ Phone_______________

Address______________________________________________________________

Email______________________________________ Age_____ Sex: M__ F__

 T-shirt size: S__M__L__XL___XXL___ 10K___ 5K____ Walker_____

-Waiver of Responsibility must be signed for registration to be considered valid.

I agree to assume all responsibility for all risk of damage or injury to me as a participant in this event. In consideration of being

acceptedas an entrant in the North Brookfield Youth Center Road Race/Walk, I hereby, for myself, my heirs,executors and

administrators, releaseand discharge all organizations and individuals associated with the race from allclaims, damages, rights

of action, present or future, whether the same be known, anticipated, or unanticipated, resultingfrom or arising out of, or in

incident to, my participation in this event.I hereby certify that I will not participate in therun/walk unless I am physically fit and

sufficiently trained for completion of the event. I alsogive permission for theuse of my name and/or picture in any broadcast,

photograph or other account of this event.

Signature (required) ____________________________________________________________________

Parent Signature (if under age 18) __________________________________________________________