The Nicholas Wilson Athletic Scholarship 5K Run/Walk will
take place on July 11, 2015.
The Nicholas Wilson Athletic Scholarship was created to
honor the life of Nicholas Wilson by assisting in furthering the education of a
New Richmond High School graduating senior.
Nick passed away suddenly on December 24, 2013 in a car
accident.
Our mission is to develop and maintain a scholarship fund
that continues to assist New Richmond High School students just like Nick for
years to come. With the Nicholas Wilson Athletic Scholarship, our goal is to
award one scholarship each year to a high school senior who meets the
scholarship criteria. As the scholarship grows with the help of fundraisers and
donations, our plan is to increase the number of annual scholarships.
If you are interested in becoming a sponsor/donor or have
any additional questions, please contact us at the contact information
below.
Nicholas Wilson Athletic Scholarship 5K Run
/ Walk
Saturday July 11, 2015 8:30 am 212 Market Street, New
Richmond, OH
*** ELECTRONIC TIMING
PROVIDED BY GHG TIMING LLC ***
REGISTER ONLINE AT www.RegistrationSpot.com *** OR *** Print and complete the entry form
below.
Name:
________________________________________________________________________
Address:_______________________________________________________________________
City, State,Zip:__________________________________________________________________
Phone:__________________ E-mail:____________________ Age on Race
Day:________
ENTRY FEE (check one)
___$30 Pre-Registration includes T-shirt ___$35 Race Day Registration,
purchase T-shirt separately if available
*** AGES 11 AND UNDER *** REGISTRATION NOT REQUIRED *** WILL NOT
RECEIVE BIB NUMBER ***
Race Division (circle one) 5K Run 5K Walk
Sex (circle one) Male Female
Shirt Size (circle one) S M L XL XXL
Make checks payable to: NREVSD (New Richmond Exempted Village School
District)
Mail checks to: Liz Misheff, 1064 US 52 New Richmond, OH 45157
*** Pre-registration entry forms must be postmarked by
Wednesday July 1, 2015 ***
WAIVER: In consideration of the acceptance of my entry, I hereby waive,
discharge and release on behalf of myself, my heirs, executors and assigns, all
claims of any nature, including but not limited to damages, demands, actions,
whatsoever in any manner, arising from my participation in the Nicholas Wilson
Athletic Scholarship 5K, and do hereby release the Village of New Richmond, GHG
Timing LLC, the race director, coordinators, all sponsors, workers, officials
and volunteers from any claim whatsoever arising from my participation in this
event. I agree to abide by all rules for participation and acknowledge that the
Race Committee may refuse or return my entry at its discretion. I attest and
verify that I understand the risks involved in such a run/walk, and that I am
physically fit and have trained adequately in preparation and I agree to pay
for my own medical expenses in the case of an accident or illness regardless of
whether I have authorized such expenses. I HAVE NOTED ANY MEDICAL CONDITION on
this form below. I permit the use of my name and picture participating in this
event for publicity.
Relevant Medical
Conditions:________________________________________________________________
ENTRANT SIGNATURE:__________________________________ Date:
_____________
Parent or Legal Guardian signature
for participants under age 18 ________________________________Date:
____________
Emergency
Contact__________________________________________Phone___________________
*** ALL REGISTERED
PARTICIPANTS WILL BE ENTERED IN DOOR PRIZE DRAWINGS !! ***
