BLUE JAY 5K
Join us in celebrating Saint Dominic School’s 50th Anniversary
with a 5k run through Ocean County Park
Saturday, September 19th 9:30 a.m.
700 Ocean Avenue (Route 88) Lakewood, NJ
Ocean County Park is a USATF certified cross country course
sure to challenge runners of all ages.
Awards for top 3 to the following divisions:
Male & Female 18 & Up
Male & Female 14 - 17
Kids 13 and under receive a ribbon for completing race
Participants can register online at www.eliteracingsystems.com
All major credit cards accepted.
Mail- In Registration Form
$25 before 9/8/15 (guarantees a T-Shirt) $30 from 9/9/15-9/18/15 (guarantees a T-Shirt)
$35 day of event. T-Shirt upon availability
First Name:______________________Last Name:_________________________________
Address:___________________________________________________________________
City: _____________________________ State: _____ Zip: ______________
Phone:__________________________E-mail:__________________________________
Date of Birth:______________T-Shirt
Birth:______________
Size (Youth Small - Adult XXL):__________________
I know that running [volunteering for] a road race is potentially hazardous activity, which could cause injury or death. I will not enter and participate unless
I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this event, am in good health, and I am properly
trained. I understand my entry fee is NON-REFUNDABLE and agree to abide by any decision of a race official relative to any aspect of my
participation in this event, including the right of any official
o
to deny or suspend my participation for any reason whatsoever. I attest that I have read the rules
of the race and agree to abide by them. Having read this waier and knowing these facts and inconsideration of your accepting my entry, I,
for myself and anyone entitled to act on my behalf, waive and release the Blue Jay 5K, and St. Dominic School,
all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that
liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
Signature: _____________________________ Date:_____________________ Parent’s Signature if under 18 years:_______________________________
Signatu
Make checks payable to Saint Dominic School P.T.A.
and mail to Blue Jay 5k 290 Delaware Dr. Brick, NJ 08723