Run (5K) or Walk (2 Miles) for the Penguins
Location: Mystic Aquarium
Help support our research and conservation efforts
Saturday, October 18th, 2014
Event begins at 9:00AM
On-site Registration ALL EVENTS 7:00 – 8:45AM (All participants MUST register)
AVOID THE LINES! Early check-in / registration Friday Oct 17th 3pm – 7pm
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5K race course on trail & road (No Strollers or Dogs will be allowed on 5K race course)
Strollers and Dogs allowed on 2 mile paved walking course only
5K race prizes (standard age divisions)
Fundraising teams may consist of up to 10 runners and walkers
Middle School X-C Team prizes (Middle school teams contact Tracy Romano for details [email protected])
• Registration includes Free Admission to the Aquarium on Race Day
• Free T-shirt for those registered by 8/31/2014
• Save time and register online: http://www.2014penguinrunwalk.kintera.org/
• Prize top individual & team fundraisers- announced 10/20
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Last Name_________________
First Name___________________
Street Address__________________________ City/State/Zip____________________
Birth Date__/__/__
Age on Race Day_______
Telephone___________
Male ____
Female____
E-Mail_______________
5K Run_____
Walk_____
Kid’s ¼ mile Race________(Starts approx 10:15)
Dogs allowed on walk only (please check if you plan to bring a dog) _______ Dogs will be watched by
Our Companions Domestic Animal Sanctuary for the portion of the walk that takes place inside the aquarium.
Please circle the correct category below: (families and teams fill out 1 form per person)
By Oct 1st
After Oct 1st
Adult
$25
$30
Child (3-13)
$15
$20
*Family (2 adults, 2 children)
$58
$68
Additional children
$13 each, Please indicate # of additional ______
*Middle school team (up to 10)
$58 School name:________________________
Additional MS children
$13 each, Please indicate # of additional ______
*PLEASE FILL OUT ONE FORM PER PERSON EVEN WITH FAMILY REGISTRATION!
Complete entry form and mail with entry fee to:
Questions: E-mail Theresa Mullin
Run or Walk for the Penguins
[email protected]
Mystic Aquarium, 55 Coogan Blvd.Mystic, CT 06355
ATTN: Theresa Mullin
Make checks payable to Sea Research Foundation
All proceeds go to help support our penguins and research & conservation efforts
All entries must be signed by the athlete (parent or guardian of athletes under 18) in agreement of the following: I hereby release Sea Research Foundation,
Inc. (including Mystic Aquarium, Ocean Exploration Center, Jason Learning, and Ocean Blue Catering, the sponsors and the officials of the Run for the
Penguins 5K, Walk and Kid’s race to be held on October 18th, 2014 from all damages or injuries incurred during or arising out of the above participation
of the individual named above in this event. I further agree that the above and its nominees and assigns may use, in their sole discretion, the likeness and/or
photography taken of me, ______________________________ (participant’s name) or any reproduction thereof, in any form, style or color, together with any
writing and other advertising material, in connection therewith, including television and including, but not limited to, the use of my name and/or quotations. This
consent and release is given without limitation upon, or liability for, any use for advertising, illustration, publication, broadcast of every kind, or in trade or media,
or for any purpose for promotion by Sea Research Foundation, Inc., and its nominees. I further agree that such photography and/or likeness, and the film, tape,
plates, and negatives thereof, shall be and remain the exclusive property of Sea Research Foundation, Inc. I further waive any right to inspect or approve the
commercial, advertising or publicity material.
I also certify that I the individual named above am in sufficient physical condition to participate in this event.
UNDER 18 YEARS OF AGE:
By right of legal authority invested in me, I individually and as father/mother/guardian of the above, consent to the foregoing.
Name of Parent or Guardian (print): _______________________________
Date: ______________
Signature of Parent or Guardian: _________________________________________________________
Signature__________________________ Witness signature ________________________________________
Registrant Name: _______________________________
Pledges:
Name
Address
Phone
$ Amount
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