RACE APPLICATION
7th Annual Seaford Hot Chocolate 5K Run/Walk
9:00AM Saturday, December 4, 2010
Seaford High School
1575 Seamans Neck Road, Seaford, NY 11783

Proceeds To Benefit Seaford Youth Programs - Hot Chocolate & Bagels afterwards for all runners!

ENTRY FEES - (no refunds): $20.00 pre-registered runners (through 12/2/2010)
$25.00 thereafter including race day  (BABY STROLLERS PROHIBITED)
Start & Finish: Seaford High School
REGISTER ONLINE AT WWW.ACTIVE.COM, OR PRINT THIS FORM AND RETURN WITH ENTRY FEE.
RACE RESULTS BY: FINISH LINE ROAD RACE TECHNICIANS (WWW.FLRRT.COM)

Course:  Start Seamans Neck Rd. 100 yards South of Seaford High School, North to Jerusalem Ave.,
East to Washington  Ave., South to Brooklyn Ave., West to Seamans Neck Rd.,
North to Finish at Seaford High School.  

Awards:  Overall Male & Female - Masters (age 40 and over) Male & Female -
Overall Seaford Resident Male & Female (Sponsored by the Seaford Lions Club.)
Medals:  Age Groups: Top 3 Male & Female for 9 and under, then 5 year age groups to 80+
Centipedes Welcome! (minimum 5 runners per centipede) Medal for First place centipede

Race # & T-shirt pick-up: Friday 12/3/2010 :  5:00PM - 9:00PM   Saturday 12/4/2010 :  7:30AM - 8:45AM
Seaford High School Auditorium, 1575 Seamans Neck Rd., Seaford, NY 11783

Information contact: Michael Di Silvio mjd455@optimum.net  516-384-8536

Mail form and fee made payable to:  Seaford Wellness Council, 3940 Sunset Avenue, Seaford, NY 11783
___________________________________________________________________________________

Name: ____________________________________________________          Male / Female:_________

Address: __________________________________________________         
                                                                                                                              
Town, State, Zip: ____________________________________________            

Phone: ________________________________ Age on Race Day:______        Date of Birth:_________  

E-mail: _____________________________________________

_______________________________________________    Date:_______
Signature (Signature of parent or guardian if under 18 years of age)
In signing this form for myself (or participant below if he/ she is under 18), I understand and agree to absolve Seaford UFSD and The
Seaford Wellness Council, and all sponsors, be they individuals or organizations, singly or collectively, of all blame for any injury,
misadventure, harm, loss or inconvenience suffered in any of the activities associated with the said event.  I attest and verify that I am
physically fit and have sufficiently trained for the completion of this event, and that my physical condition has been verified by a licensed
Medical Doctor.  “The distribution of this flyer by the Seaford School District is a courtesy extended to the activities of this organization. In
no way does the Seaford School District sponsor or accept any responsibility for these activities.”