Registration Form
Saturday, October 22, 2011
8am at Westgate Park

Okay Kids, It’s time to start thinking about the Dothan Kids Marathon!  Dust off your running shoes and start tracking miles. 

About the Kids Marathon:  The Dothan Kids Marathon is a 1.2 mile run for children in Kindergarten to 8^th grade.  Adults train all year long to be in shape to run the full marathon distance.  You have the opportunity to run your own marathon!  You will run 25 miles during the weeks leading up to race day.  Our mission is to promote kids’ health and fitness in a fun and creative way.  We hope to encourage kids and their families to maintain their health and fitness through the rest of the year and throughout their lives.

How do I register:  Complete the entry form below.  The entry fee is $20, which includes a t-shirt, goodie bag, racing number, and medal (upon completion of the race).  Kids should register before September 30, 2011 to guarantee a t-shirt.

Check-In:  You will check in on Friday, October 21, 2011 between 5pm – 7pm at the James Grant Recreation Building.  You will receive your goodie bag with t-shirt and race number.  Volunteers will be available to answer your questions.

Race Day:  On Saturday, October 22^nd, 2011, bring your family to Westgate Park in front of the James Grant Recreation Building.  Plan to arrive by 7am so you can get settled and stretch before the race.  We will have separate start times for the age groups so make sure you check for your time.

Contact Stacy Patel at hcmedicalalliance@gmail.com or (334) 446-1515 for more questions.

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Last Name:___________________________________  First Name:__________________________________ (please print)  

 Circle One:   Male  or Female     Date of birth(mm/dd/yyyy):________________   Age on Race Day:_________

Street Address:____________________________________________________Apt. #____________

City:____________________________   State:________  Zip:______________  Phone #:____________________

School:__________________________________________    Email for updates:_________________________________

Shirt Size (circle one):  Youth Medium       Youth Large        Adult Small          Adult Medium 

Waiver:  Read this and then sign and date form below:  ALL PARTICIPANTS IN THE DOTHAN KIDS MARATHON ARE REQUIRED TO ASSUME ALL RISK OF PARTICIPATION IN ALL STAGES OF THE EVENT BY SIGNING THIS GENERAL RELEASE AGREEMENT.  The undersigned athlete (Athlete) and on behalf of the Athlete’s personal representatives, assigns, heirs, and executors, fully and forever releases from all liability, including negligence, The Houston County Medical Alliance, the City of Dothan, Houston County, all municipal agencies, all sponsors related to this event whose property or personnel are used in this Event.  Athlete and on behalf of Athlete’s personal representatives, assigns, heirs and executors waives the right to sue Releasees for all losses and damages that arise from any injury to Athlete or Athlete’s property or resulting in Athlete’s death in connection with the Athlete’s participation in the Event including but not limited to losses or damage caused by negligence of all or any of the Releasees or otherwise, and any pre-race or post-race activities and any programs and/or giveaways conducted at the events/ activities by a sponsor or other third party.  The Athlete warrants that Athlete is in good physical condition and is able to safely participate in the Event.   The Athlete is fully aware of the risks and hazards inherent in participating in the Event and elects to voluntarily compete in the Event knowing such risks.  The Athlete agrees to the use of Athlete’s name and photographs in broadcasts, newspapers, brochures, and other media without compensation.  The Athlete acknowledges that the entry fee is non-refundable and nontransferable.  The Athlete acknowledges that the Houston County Medical Alliance has the right to alter, change, cancel and/or postpone the event as a result of circumstance that would affect or impact the event which are beyond their control.  The Athlete warrants that all statements made in this release agreement are true and correct and understands that Releasees have relied on them in allowing Athlete to participate in the Event.  ATHLETE HAS READ THE FOREGOING AND INTENTIONALLY AND VOLUNTARILY CERTIFIES COMPLIANCE BY ACCEPTING THIS WAIVER.

 ____________________________________________________________________________ ______________________________________________

Signature of Participant (REQUIRED)                  Date                                                             Signature of Parent or Guardian (REQUIRED)               Date

DO NOT SEND CASH:  This completed form must be turned in by September 30, 2011. 
Make check or money order payable to:  Houston County Medical Alliance.  Forms and Fees can be turned in at the James Grant Recreation Center Office during regular business hours. 

            Dothan Kids Marathon 2011

                    Official Tracker

          Dothan Kids Marathon Tracker for:___________________________________________
                                                                       Name of Runner