PRE-REGISTRATION: $30

Must be received at LHM by August 13th, 2014

REGISTRATIONS after August 13th: $40

Day of Race Registration: 7:45am - 8:45am
Race Begins: 9am

For Information: www.lifehousewa.org
Call (360) 548-3177 OR email
info@lifehousewa.org
Return form & make checks payable to:
LHM, 8825 34
th
Ave NE Suite L-179,
Marysville, WA 98271
All registration fees are NON-REFUNDABLE
First Name:_________________________________________Last Name:__________________________________________
Email: _________________________________________________________________________________________________
Address:____________________________________ City:_______________________ State:________ Zip:______________
Home Phone: (_____)_________-__________ BIB Number (Staff Use):____________________________________________
Distance: 5K Run or Walk SEX: male female
AGE: 14 & under ($10) 15-19 20-29 30-39
40-49 50-59 60-69 70 & over ($10)
T-SHIRT: small medium large x-large NO SHIRT
NOTE: Pre-registering for the event will increase the likelihood that a shirt will be available to you, especially in the correct
size. Although we do our best to order enough T-shirts; we cannot guarantee size or availability of T-shirts, especially on
the day of race. T-shirts and Awards will not be mailed to you.

I am aware that participating in running events involves certain risks of physical injury and death, and that I should consult with a physician
concerning participation in said events. I understand that the course is not closed to traffic. Being fully informed as to these risks and in
consideration of being given the privilege to participate in the ARC event(s), I hereby, on behalf of myself and my heirs, assume all risks in
connection with my participation in this program and I further hold harmless and agree not to sue the City of Arlington; ARC, its members,
employees, agents and volunteers; the charity; Snohomish County, its officers, elected officials, agents and employees; all sponsors and
contributors for any injury or damages which may occur to me while I am participating in the event(s) and I waive any right to bring claim or
lawsuit against them for any such injury, damage or death. Furthermore, I agree to hold harmless, defend and indemnify the City of Arlington;
ARC, its members, employees, agents and volunteers; the charity; Snohomish County, its officers, elected officials, agents and employees;
all sponsors and contributors from any and all claims and lawsuits for injury, loss or damage to other persons or entities which may rise in the
future as a result of or in connection with my participation in the ARC event(s).

***WARNING: For safety reasons, no skateboards, skates, bikes or dogs will be allowed on the course. ARC, Life House & Hope Unlimited
relies on volunteers to staff the course. There may NOT be volunteers on the course approximately 75 minutes after the race starts. If
participating in the 5k run but cannot cross the finish line within 75 minutes, you need to know the volunteers, course directions and course
timing equipment may be taken down or in the process of being taken down after the race has been running for more than 75 minutes.
I authorize any necessary emergency medical treatment that might be required for me in the event of physical injury and/or accident to me
while participating in the event(s). I acknowledge that all race event and membership registration payments are non-refundable and non-
transferable. I HAVE CAREFULLY READ THIS RELEASE AND HOLD HARMLESS AGREEMENT NOT TO SUE ARC, Life House Ministries
or Hope Unlimited AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT IT IS A FULL RELEASE OF ALL LIABILITY AND
SIGN IT ON MY OWN FREE WILL.

_______________________________ _____________________________________________________
Date Signature of Participant (Parent/Guardian, if participant is under 18)
Life & Hope 5k
Saturday, September 13
th
, 2014 - 9:00 am
Haller Park 1100 West Ave, Arlington, WA 98223
Join this 5k and support Life House Ministries
**The course volunteers leave intersections 60 minutes after the start of the race