37 th Annual Buckley’s - Kennedy’s Run HeartShare Human Services of NY 12 MetroTech Center, 29 th Floor Brooklyn, New York 11201 Address Service Requested 2017 Buckley’s - Kennedy’s Run Runner Sponsors Form PLEASE PRINT CLEARLY 2017 Buckley’s - Kennedy’s Run Registraon Form PLEASE PRINT CLEARLY Sponsor’s Name Amount 1. ___________________ $ ____________ 2. ___________________ $ ____________ 3. ___________________ $ ____________ 4. ___________________ $ ____________ 5. ___________________ $ ____________ 6. ___________________ $ ____________ 7. ___________________ $ ____________ 8. ___________________ $ ____________ 9. ___________________ $ ____________ 10. __________________ $ ____________ 11. __________________ $ ____________ 12. __________________ $ ____________ All sponsor donaons are fully tax deducble. Make checks or money orders payable to HeartShare Human Services We strongly encourage you to ask family, friends and co-workers to sponsor you. If needed, you may copy this sheet for addional sponsors. First Name Last Name Address City State Zip Phone Email Gender: Male Date of Birth Age Female T-Shirt Size: Have you run this race before? Small Yes Medium No Large Is this a new address? X-Large Yes 2X-Large No Runner #_________ Amount: $ ___________ Waiver of Liability (Must be signed): I understand that HeartShare Human Services of New York and all other organizaons or persons connected with this event are not responsible for any injuries which I may suffer while taking part in this event or as a result thereof. I hereby waive any claim of damages to my person and/or personal property. Runner: __________________________________ _________________________________________ Parent/Guardian (if runner is under 18 years old) 37 TH ANNUAL Buckley’s - Kennedy’s 5K Charity Run SUNDAY, MAY 21, 2017 10:00 AM • RAIN OR SHINE In Loving Memory Of Kevin “The King” Roche and Pudgie Walsh All Proceeds Benefit
All sponsor donati ons are fully tax deducti ble.Make checks or money orders payable to
HeartShare Human Services
We strongly encourage you to ask family, friends and co-workers to sponsor you. If needed, you
may copy this sheet for additi onal sponsors.
First Name Last Name
Address
City State Zip
Phone
Email
Gender:
Male Date of Birth Age
Female
T-Shirt Size: Have you run this race before?
Small Yes
Medium No
Large Is this a new address?
X-Large Yes
2X-Large No
Runner #_________ Amount: $ ___________
Waiver of Liability (Must be signed):I understand that HeartShare Human Services of New York and all other organizati ons or persons connected with this event are not responsible for any injuries which I may suff er while taking part in this event or as a result thereof. I hereby waive any claim of damages to my person and/or personal property.
Runner: __________________________________
_________________________________________Parent/Guardian (if runner is under 18 years old)
37TH ANNUAL
Buckley’s - Kennedy’s5K Charity Run
SUNDAY, MAY 21, 201710:00 AM • RAIN OR SHINE
In Loving Memory OfKevin “The King” Roche
andPudgie Walsh
All Proceeds Benefi t
37TH ANNUAL Buckley’s - Kennedy’s 5K Charity Run
SUNDAY, MAY 21, 2017 • 10:00 AM • RAIN OR SHINE
RUNNER INFORMATIONRunners arrive at 9:30 am in front of the Army Reserve Center, located on Rockaway Point Blvd/State Road between Barret Road and Hero Road in Breezy Point, NY. For GPS, use the address of St. Genevieve’s Church: 6 Beach 178th Street, Breezy Point, NY 11697 located across the street from the Reserve Center.
Runners clothing must be placed in plastic bags prior to race time. Immediately following the race, runners may pick up their clothes near the runners entrance to the Family Fun Day Picnic. Strollers are allowed behind the field of runners.
PARKING & SHUTTLE BUS INFORMATIONRunners and picnic guests may park in the Army Reserve Center parking lot. Shuttle buses will run between the parking lot and the Breezy Point baseball field from 8:30 am until 4:00 pm. You will not be able to park in Breezy Point.
TROPHY INFORMATIONTrophies are presented to the overall fastest male and female participants and to the top three males and females in each of the following age groups:
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