This document provides information about a 5K run and 1 mile walk being held by the Northwood FF Memorial Run. Participants can choose to do the 5K or 1 mile walk and must select an age group. Medals will be given to the top male/female overall and the youngest/oldest as well as the top 3 in each age group. The registration fee is $10 before June 18th and $15 after. By signing the waiver, participants agree to not hold the event organizers responsible for any injuries and certify they are physically able to participate.

1. MAIL TO: Northwood FF Memorial Run, 2100 Tracy Rd, Northwood Oh 43619
EMAIL TO: chiefpwojo@aol.com
I will be participating in: 5K ( ) 1 Mile Walk ( )
Age Group: _ 17 & under _18 – 29 _ 30 – 39
_ 40 – 49 _ 50 – 59 _ 60 & over
Medals to top male/female overall, youngest/oldest and top 3 all age groups
Registration Fee: $10.00 before June 18, 2012 - $15.00 after June 18, 2012
WAIVER STATEMENT: (entry invalid if not signed)
I assume full and complete responsibility for any injury or accident which may occur to me during
the race or while I am on the premises of the event, and I hereby release and hold harmless the
Northwood Fire Fighters Association, City of Northwood, the sponsors, promoters and all other
persons and entities associated with the event or their agents or employees or otherwise. I
further certify that I am in good physical condition and fully able to participate in this event. I
understand that fees are not refundable and that bikes, skateboards, skates or glass are not
allowed.
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Entrant’s signature (if under 18, signature of legal guardian required)