Fall Festival Sunday, September 13, 2015
Registration starts at 8:00 a.m. in the Prairie Lane Pool parking lot
11550 Prairie Lane Drive. Run starts at 8:30 a.m.
Refreshments immediately following Fun Run!
Get your shoes and grab your walking partner, for a
3.0 mile RUN or WALK the 1.5 mile course.
Entry fee: $12.00 per person or $40.00 per family.
Registrations received by Friday, September 4th, 2015 will include a T-shirt.
Registrations will be accepted up to the date of the run, t-shirts not guaranteed.
All ages are welcome.
Children under the age of 10 must have an adult chaperone.
Mail registrations to: Dan Tietjen, 3409 S. 114th St., Omaha, NE 68144
or drop off at MOQ parish or school office
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MOQ Fun Run/Walk Release
I, the participant, or parent/guardian of the minor participant(s), agree that I and/or the minor participant, recognizing the possibility of physical injury
associated with the Fun Run/Walk, hereby, release, discharge, and/or otherwise indemnify the MOQ Athletic Committee, its affiliated organizations and
sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Fun Run/Walk, against any claim by, or on
behalf of myself or the minor participant(s) as a result of my or the minor participant(s)' participation in the Fun Run/Walk. For myself, and as a parent or
legal guardian of the minor participant(s), I hereby give my consent for emergency medical care prescribed by a duly licensed doctor of medicine or a doctor
of dentistry. This care may be given under whatever conditions are medically necessary.
Participants Name(s):
_____________________________________________________________
Email address:
_____________________________________________________________
Signature, or if Minor,
Parent/Guardian Signature:
_____________________________________________________________________________
Date:
___________________________
T-Shirt Size(s) & Quantity:
______YM _____YL _____AS _____AM _____AL _____XL ______XXL
Amount Paid: $________________
Please make checks payable to Mary Our Queen Athletic Committee.