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Physical Therapy Run-Walk Aids OBGC

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Northern Physical Therapy is excited to announce that it will be sponsoring its third annual Spring Into Fitness 5K Road Race and One Mile Fun Run/Walk. The event will take place Saturday, May 26 and all proceeds from the event will benefit the Ogdensburg Boys and Girls Club. The One Mile Fun Run/Walk will begin at 9:30 am at Northern Physical Therapy, 203 State Street, in Ogdensburg NY. The 5K Walk/Run will follow the Fun Run and begin at 10 am.

Registration forms are available at Northern Physical Therapy or www.northernrunner.org.

Particpants can also register by calling 393-2024 to register!

Pre-Registration for the 5K is $15 and Race Day Registration for the 5K is $20. Pre-Registration for the Fun Run $10 and Race Day Registration Fun Run is $15

T-shirts are guaranteed to 1st 100 registrants

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SPRING INTO FITNESS 5K ROAD RACE



Name_____________________Walking____Running_____Age____



Phone Number__________________Date Of Birth_____________



Emergency Contact-Phone Number_______Email Address__________



Release of Liability

In consideration of my application for entry in this event, I hereby agree to make the following agreements. I fully realize the inherent dangers of participating in the event and fully assume the risks associated with such participation. I hereby waive the sponsors, volunteers or anyone involved in the promotion of this event for any damage resulting from this event. My signing this agreement releases all the sponsors, volunteers, and promoters of this event from any liability.

Parent or Guardian of a minor (minor is defined as under the age of 18)

I, am parent or guardian of the below named minor, hereby give my permission for my child to participate in the event, and further agree, individually and on behalf of my child to the terms above.

Release for Media Recording

I hereby consent and agree that Northern Physical Therapy, their employees, or agents have the right to take photo-graphs, videotape, or digital recordings of me on May 28, 2011 to use in any and all media, now or hereafter known, and exclusively for the purpose of promotion and marketing. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I hereby release Northern Physical Therapy, their agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to mar-ket and sell copies. I waive any right, claims, or interest I may have to control the use of my identity or likeness in whatever media used.

Signature of Participant___________________Date________________



Parent/Guardian if under the age of 18________________________

Mail Applications to Northern Physical Therapy 203 State Street

Ogdensburg, New York 13669, Attn: Carrie Montgomery

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