The Hamburg Area High School’s National Honor Society is hosting:
ENDURE FOR A CURE
5K Race/0.5 Mile Fun Run
Hair Donation Event
Saturday, April 6, 2013
April is National Cancer Control Month. All proceeds from Endure for a Cure will benefit the American
Cancer Society. Help raise awareness and monetary benefits for those whose lives have been affected
by cancer.
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The event will be held on Saturday, April 6, 2013, at the Hamburg Area High School Football Stadium.
Registration will begin at 8:30 a.m. and the race will start at 10:00 a.m.
Awards will be given to the first, second, and third places for each male and female age group and overall
for the 5K Race. Awards will be presented after both races are completed. The following are the age
groups (for both males and females):
U13, 14-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70 and older
An Assortment of Raffle Baskets, a Food Stand, a Hair-donation stand, and other opportunities to donate
will also be available. See other registration form if you are interested in registering for a hair donation.
There is no age limit for the 0.5 Mile Fun Run. Those who participate in the 0.5 Mile Fun Run will be
charged no fee, however, if they want a t-shirt, they will have to pay the $15 T-shirt Fee. T-shirt sizes and
availability will be guaranteed if registered before March 9th.
All 5K Race participants who register by March 9th will be guaranteed a t-shirt with their $20 entry fee.
Shirts will not be guaranteed after March 9th.
Entry Fee: $20
Day of Race: $25
* I plan on participating in (circle one): 5K Race 0.5 Mile Fun Run
Last Name:______________________________________
First Name:__________________________________
Address:_______________________________________________ City:___________________________________
State:________ Zip:_______________
Gender: M F
Age as of April 6th: __________
Date of Birth(mm/dd/yy):_____________________ Email:______________________________________________
Phone: ____________________________________
T-Shirt Size(Please circle one): ADULT- S M L XL XXL
YOUTH- S M L XL
*Note: T-shirts are not guaranteed for participants who register after 3/09/13.
The following fields are required:
Emergency Contact:_______________________________________ Phone:________________________________
Relationship:_______________________________ Attending Race on 4/06/13: yes no
Waiver: I acknowledge that participating in a 5K race/0.5 mile fun run by running or walking poses a potential hazard to my health. On behalf of
myself, my heirs, executors, administrators, successors and assigns, I hereby waive and release all rights and claims for damages which I may
have against you or your assigns, the municipalities in which the event occurs, or anyone connected with this event, for any and all injuries or
illnesses which I may suffer as a result of taking part in the event. I grant my permission to use my name or any audio or visual recording for any
lawful purpose. I understand that volunteers will be on hand to guide participants, but roads may be open to traffic.
______________________________________
Signature
_____________________________________________
Parent/Guardian Signature if under 18 years of age
Please make checks payable to: Hamburg Area High School
Send all Registration forms and money to:
Hamburg Area High School Attn: Michelle Cinicola
701 Windsor Street
Hamburg, PA 19526-0401
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Date
SHORT HAIR BECAUSE WE CARE.
Locks of Love Hair Donation Event
All eligible hair donations will be sent to Locks of Love, see www.locksoflove.org.
 Will take place during the Endure for a Cure 5K Run/Fun Mile Walk at the Hamburg Area High
School Football Stadium. Haircutting time slots will take place before, during, and after the race.
 If you wish to donate your hair and participate in the run you may gladly do so! Just fill out the
5K Run/Fun Mile Walk Registration Form in addition to the Hair Donation Form. If you are only
interested in donating your hair then simply fill out the Hair Donation Form with no fee required.
You may pre-register or register the day of the race – 4/06.
 A free haircut and prizes will be available to all who donate their hair!
In order to be acceptable to donate, your hair must follow the guidelines (taken from
www.locksoflove.org):
 10 inches measured tip to tip is the minimum length needed for a hairpiece.
 Hair that is colored or permed is acceptable.
 Hair that has been cut years ago is usable if it has been stored in a ponytail or braid.
 Layered hair is acceptable if the longest layer is 10 inches, and may be divided into multiple
ponytails.
 Curly hair may be pulled straight to measure the minimum 10 inches.
 Hair that has been bleached (usually referring to highlighted hair) is not usable.
 Hair must be gathered and cut in a ponytail or braid. You may divide your hair into multiple
ponytails to cut the hair.
 No dreadlocks, wigs, falls, hair extensions or synthetic hair can be accepted.
Last Name:________________________________ First Name:_________________________________
Address:________________________________________ City:__________________________________
Zip: __________ Gender: M F
Age:________ E-mail Address:_________________________________
Would you prefer to have your hair styled after it is cut? Yes No
T-shirt size(please circle one): ADULT- S M L XL XXL
YOUTH- S M L XL
Please choose how you would like to receive your acknowledgement. (Receiving an acknowledgement could take
up to 90 days):
Mail
E-Mail
Waiver: I acknowledge that participating in the Hair Donation Event may not guarantee full satisfaction with my hair cut, style, etc. On behalf
of myself, my heirs, executors, administrators, successors and assigns, I hereby waive and release all rights and claims for damages which I may
have against you or your assigns, the municipalities in which the event occurs, or anyone connected with this event, for any discontent that
may result from the event and any injuries or illnesses which I may suffer as a result of taking part in the event. I grant my permission to use my
name or any audio or visual recording for any lawful purpose.
_______________________________________ ____________________________________________ ____________________
Signature of Participant
Signature of Parent/Guardian if under 18 years of age
Date