Partner With Youth 5K

ALL PROCEEDS
ALL PROCEEDS
BENEFIT THE
BENEFIT
YMCA’s
THEPARTNER
YMCA’s PARTNER
WITH YOUTH
WITH
CAMPAIGN
YOUTH CAMPAIGN
Partner With Youth 5K
5K RACE BEGINS AT 8:00 A.M.
5K RACE BEGINS AT 8:00 A.M.
1 MILE FUN RUN BEGINS AT 9:00 A.M.
1 MILE FUN RUN BEGINS AT 9:00 A.M. SEPT.
SEPT.1818
For more information, contact Karen Duffy
For more information, contact Karen Duffy
teamduffy@gmail.com  |  678-491-0639
teamduffy@gmail.com  |  678-491-0639
Register online at www.active.com
Register online at www.active.com

Race starts
Race starts
at 1350
atScenic
1350 Scenic
Highway,
Highway,
Suite 356
Suite
Snellville,
356 Snellville,
GA 30078
GA 30078

First Name_____________________________________ Last Name_______________________________________

Street Address___________________________________ City____________________ State_____ Zip__________
E-mail __________________________________ Home Phone_________________ Work Phone____________________
Date of Birth_______________ Age on Race Day______ Male r Female r • T-Shirt Size : YL r Sr Mr Lr XL r
Entry fee for 5k is $20 per individual • Late 5k registration is $25 per individual • Walk-in registration is welcome! • Rain or Shine
Entry fee for 1-Mile Fun Run is $5 per individual • Late Registration for 1-Mile Fun Run is $10 per individual
MAKE CHECKS PAYABLE TO: Karen Duffy • MAIL TO: 42 Lakecrest Circle, Suwanee, GA 30024
Participant Signature____________________ Date ______ Guardian Signature_________________________ Date_________
WAIVER: I hereby for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have against the Race
Organization and any sponsors, coordinating groups, and any individuals associated with the event. I attest that I am physically fit to compete in this event. Further,
I hereby grant full permission to any and all of the foregoing to use my photographs, video tapes, motion pictures, recordings, or any other record of this event for
legitimate purpose.