DragonFly Note

Mail Registration and Check to: Brenton’s Hope: 353 Robin Dr., Nazareth, PA 18064 Checks payable to: Brenton’s Hope Register online at:
www.brentonshope.org

Date:

Time:

September 28th, 2013

Check-In at 7:30am, Fun Run at 9:00am, 5K Run/Walk 9:30am

who have been devastated by childhood cancer.

Eleven-year old Brenton Krouse lost his battle with Leukemia in June, 2009.
His courage and hope have been an inspiration to many.
Please help us raise awareness and support local families

Place:

Entry Fee:

Nazareth Middle School
94 Friedenstahl Ave, Nazareth PA, 18064

$20 pre-entry (includes Running Shirt if postmarked by 9/10/11)
$25 after 9/10/11 and on race day (includes Running Shirt if available)

Awards:
*Top 3 Male and Female in each age group*

Amenities: Indoor facilities and refreshments for all, convenient parking. Held rain or shine. Results posted on www.brentonshope.org within 5-6 days.
Course: Beautiful, scenic road course through Historic Nazareth. Visit www.brentonshope.org for a
Address:________________________________________________________________
City:___________________________ State:____________ Zip:____________________
Phone:______________________ E-mail:______________________________________ Circle One:

course map.

Please Print Clearly Name:_____________________________________________ Gender(M/F):_________

Event: 5K Run 5K Walk Race Day Age: 10-Under 11-14 Shirt Size: YS YM YL S

Fun Run (10-Under only)
15-19 20-29 30-39 40-49 50-59 60+
M L XL XXL XXXL

WAIVER – I hereby waive and release any and all rights and claims I may have against Brenton's Hope Foundation, the town of Nazareth, and the Dragonfly 5k Run/Walk sponsors for damages which I may have arising out of this event. I certify that I am physically fit and able to participate in this event. "Further, I hereby grant full permission to any and all of the foregoing to use any pictures, or any other record of this event for any purpose whatsoever.” If signed by a parent or guardian, the parent or guardian agrees to release and hold the above named organizations and persons harmless of any claims which may be asserted by or on behalf of the entrant.
Signature:______________________________________________________ Date:_____________ Parent/Guardian Signature_________________________________________ Date:_____________