ࡱ > J L I V bjbj 00 e e V . . . . . B B B B L B 2 l l l l G " i u $ J . } G G } } . . l l } . l . l } l sGs 0 . l } } } } } } } } } } } } } } } } } } } : 3rd Annual D.E.F.F.
(Dearborn, Edsel Ford, Fordson)
Unity Run!
(A joint venture between Dearborn, Edsel Ford and Fordson High Schools)
Sunday, October 11th 2015 at Ford Field in Dearborn
First Name____________________________ Last Name____________________________________
School________________________ Gender______________ Student Id_________________
Address____________________________________________________ Zip___________________
Phone ___________________________ Check one: Student PRIVATE "" MACROBUTTON HTMLDirect Staff PRIVATE "" MACROBUTTON HTMLDirect Parent PRIVATE "" MACROBUTTON HTMLDirect Other PRIVATE "" MACROBUTTON HTMLDirect
Please specify other _________________________________________________________________
RACE(check one):
1 mile walk PRIVATE "" MACROBUTTON HTMLDirect Begins at 9:30AM
1 mile run (Elementary School only) PRIVATE "" MACROBUTTON HTMLDirect Begins at 10AM
2 mile run (Middle School only) PRIVATE "" MACROBUTTON HTMLDirect Begins at 10:30AM
5K run (Adult) PRIVATE "" MACROBUTTON HTMLDirect Begins at 11AM
5K run (High School student) PRIVATE "" MACROBUTTON HTMLDirect Begins at 11AM
SHIRT SIZE(circle one):
Adult XS S M L XL XXL
Youth XS S M L XL
REGISTRATION INFO:
Registration includes a T-shirt and number bib. Accepted payments are cash, check or credit card.
Student $10 Staff/Adult $25 Team of four $35(student) $80(Adult)
Team Name:________________________________ (Each person on your team will need to complete a registration.)
I(we) will be entering the individual or team costume competition: Yes PRIVATE "" MACROBUTTON HTMLDirect No PRIVATE "" MACROBUTTON HTMLDirect
Submit registration with cash or check to Stacy Rumler at DHS, 19501 Outer Drive, Dearborn, MI 48124. Checks should be made out to: Dearborn Public Schools. You can pay with a credit card by calling Stacy Rumler at, 313-827-1628. You can register online at: HYPERLINK "http://goo.gl/forms/wSo5iYpwo4" http://goo.gl/forms/wSo5iYpwo4 OR HYPERLINK "http://www.runmichigan.com/calendar/event_detail1.php?recordID=13236"http://www.runmichigan.com/calendar/event_detail1.php?recordID=13236
Medals will be awarded for 1st, 2nd and 3rd place (male/female) in each event except the 1-mile walk. Parking is off of Brady Street as well as Cherry Hill. The unpaved trail course will be a combination of slight hills and straight pathways through a mostly wooded area. Proceeds will benefit scholarships for DPS student(s) involved in anti-bullying, mediation, diversity and/or social justice. No refunds will be issued for any reason. Please dress appropriately and for the weather.
Questions? Tara Haddad-EFHS at, HYPERLINK "mailto:haddadt@dearbornschools.org" haddadt@dearbornschools.org, Anna Schankowski-FHS at, schanka@dearbornschools.org, Stacy Rumler-DHS at, rumlers@dearbornschools.org, Visit us at, Twitter-UnityRunDEFF and Facebook.com/deffunityrun.
WAIVER: Please accept my entry for the 3rd Annual D.E.F.F. Unity Run. I hereby state I have conditioned myself to participate in the event I have chosen. I, or executors, my administrators, assignees, and myself do hereby release and discharge Dearborn Public Schools, and any business associated with the race route from damages, personal injuries, or expenses associated with my participation in the run for any and all purposes. By signing my name below, I hereby certify that I have read all the terms and conditions of this release and do intend to be legally bound thereby. I also understand that I may be photographed during the event. Check box to confirm you understanding of the waiver. PRIVATE "" MACROBUTTON HTMLDirect
Signature______________________________________________________ Date______________
Parent or Guardian signature if under 14________________________________________________
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