First Name ___________________ Last Name ___________________ Sex: M / F Age : _____

1. All proceeds benefit Owen’s Place. The race will start and finish at Owen’s Place, Rotary Park, 1 p.m.. Register Online and Donate at www.keysports.net. The race is open to runners/walkers/ and wheel chair participants. Age Divisions: 10 & under, 11-15, 16-19, 20-29, 30-39, 40-49, 50+ Refreshments will be available at the finish. • First Name ___________________ Last Name ___________________ • Sex: M / F Age: _____ • Address _______________________________________________ • City _________________________ State _______ Zip __________ • Email ________________________ • Telephone _________________________________ • Shirt Size (circle): Youth M L Adult S M L XL XXL XXXL • Emergency Contact ___________________ Emergency Contact Phone ____________________ • Entry Fee: • $20 on or before Sept. 20th $25 after Sept. 20th • Add $2 for XXL or XXXL shirt • Checks Payable to: Key Sports • Mail Entry: Key Sports • 71 Laura Ave. • Centerville, OH 4545 RELEASE: In consideration of the acceptance of my entry, I for myself, my executors, administrators and assignees, do hereby release and discharge all sponsors and individuals assisting in the presentation of Owen’s Place 5K Run/Walk for all claims of damages, demands and actions whatsoever in any manner arising or growing out of my participation in this event. This includes the race director, sponsors, and promoters. I attest and verify that I have full knowledge of the risk involved in this event and I am physically fit a sufficiently prepared to participate in the event. Signature _________________________________________ Date ___________ (Parent/guardian signs for participant less than 18