2017 Trout Run 5k registration form

                                         THE DEPOSIT CHAMBER OF COMMERCE

                                                       TROUT RUN 5K RACE

                                                                                          Saturday, April 29, 2017

                                                                                         Run begins at 10:00 am

                                                                           Race Day Registration 9:00 am to 9:45 am

Registration fee to run:

Pre-registration until April 14, 2017                                                 $12 per person (no shirt) 

                          $18 per person (with shirt)

                                                        $5 for DCS students (no shirt)  

                          $11 for DCS students (with shirt)

                  Shirt Size S M L

Registration after April 14                                         $20 per person (no shirt)

Note:  Limited quantity of shirts available first come first served with registrations. Any extras will be available for sale race day for $10 each.


Make checks payable to:                                      Deposit Chamber of Commerce

Mail registration and checks to:                                  Attn: Trout Run Registration

                                                    Deposit Chamber of Commerce

                                                                  PO Box 222

                                                              Deposit NY  13754

With race questions, please contact Bill Morley almorley@echoes.net  607-217-9130

Awards to top three male and female finishers, and top finishers male and female in each age category (no duplicates):


Ages 9 and under

10 to 14

15 to 19

20 to 29

30 to 39

40 to 49

50 to 59

60+


Last Name:_________________________________________ First Name _____________________________________


Gender:_______ Male _______ Female Age on race day_________ DOB________________


Street Address:____________________________________________________________ E-mail Address:______________________________


City________________________________ State_________________________ Zip________________________


Waiver:  I know that running a road race is potentially a hazardous activity.  I should not enter and run unless I am medically able and properly trained.  I agree to abide by any decision of a race official relative to my ability to safely complete the run.  I assume all the risks associated with running this event including, but not limited to, falls, contact with other participants, the effects of weather, traffic, and the conditions of the roads, all such risks being known and appreciated by me.  Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the race organizers, the Deposit Chamber of Commerce, the Village of Deposit, all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.  No running strollers, animals or headsets/ear buds are allowed during this race.


Signature___________________________________ Date_______________________________


Parent’s Signature___________________________________________________ Date_________________________________

(if under 18 years old)

NOTE:  No pets, strollers or wheeled devices allowed on the course.  No device headsets or ear buds.  Use of these items will result in disqualification.

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