Page 33 - CFAN_Mar2014

A Benefit for the Winter Haven Hospital

Foundation Fund for Women and Children

Saturday, April 12

®
LEGOLANDFlorida

One Legoland Way

Winter Haven

5am: Race-day registration

and t-shirt pick up

7am: 5K run/walk begins

Awards presentation to follow race

Three Ways to Register
• Mail: Completed entry form with Join Buddy and his LEGOLAND friends as you play your part in a 5K run/walk benefitting the

registration fee
Winter Haven Hospital Foundation Fund for Women and Children. Weave your way throughout
• Phone: (863) 292-4138
Central Florida’s newest family theme park from the entrance through Fun Town, Miniland USA,

• Online: Active.com
LEGO® City, Water Park and the newest addition, LEGO World of Chima!
(only available through April 10; additional
transaction fee)

For more information on how to register, sponsorship opportunities or vendors:

(863) 292-4138 or whhfoundation@baycare.org

Name: ____________________________________________________________________________________________________

Address: __________________________________________________________________________________________________

City, State, Zip: ___________________________________________________________________________________________

Phone: ____________________________________________________________________________________________________
n
$35 - Adults
E-mail: ____________________________________________________________________________________________________
n$25 - Children ages 12 and under
n$10 - Winter Haven Hospital and
Sex: M F Date of birth: _______________________________ T-shirt: YM YL S M L XL 2XL

LEGOLAND Florida employees
INCOMPLETE OR UNSIGNED ENTRY FORMS WILL NOT BE ACCEPTED. In consideration of my entry being accepted, I intend to be legally bound, and do hereby for myself,
($10 per person; discount valid for one employee and one guest)
my heirs, and executors, waive all rights and claims for damages which may hereafter accrue to me against Merlin Entertainments Group Florida LLC d/b/a LEGOLAND Florida, BayCare Health System, Inc., Winter Haven Hospital or any subsidiary or political division thereof, its or their respective officers, agents, representatives, successors, assigns
and sponsors from all claims or liabilities of any kind arising out of my participation in the 2014 Citrus Classic even though that liability may arise out of the negligence or
Add $10 to registration fee if registering day of event
carelessness on the part of the entities or person named in this waiver. If I should suffer injury or illness, I authorize the officials of the race to use their discretion to have me
Fill out form and mail to:
transported to a medical facility, and I take full responsibility for this action. I attest and verify that I am physically fit and hereby grant full permission to any and all of the
Winter Haven Hospital Foundation foregoing to use any photographs, videotapes, motion pictures, recordings, or any other record of this event for any purposes of the event whatsoever. I HAVE READ THE
ABOVE RELEASE AND UNDERSTAND THAT I AM ENTERING THIS EVENT AT MY OWN RISK.
c/o Citrus Classic
200 Ave. F N.E.
Signature___________________________________________________________ Date: ______________________________
Winter Haven, FL 33881
(Parent’s signature if under 18 years of age)

March 20 postmark guarantees a t-shirt size.
BC1401039-0314