Location: Taylor’s Pit in Cedarville, MI. 1 mile north of intersection at M-134 & M-129.
Start Time: Kids run first at 12:30pm (Please note: If you prefer to be in the same wave as someone else, please pick up
your packets at the same time. Once assigned a wave, changes cannot be made.)
Course: 5k obstacle course run or walk with mud, sand, hills, and multiple obstacles. There will
also be a ¼ mile kids obstacle course run designed just for children.
Awards: Top 3 in each age category, top three in the Kids Fun Run, best individual costume, & best
Age Groups: Male and Female: 14 & under, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70+
5K Teams/families: Minimum of 4 person, no max. Adult team members will receive a $5 per person
Packet Pickup: Race day @ Taylor’s Pit
Registration: On line at active.com or by mail: P.O. Box #460, Cedarville, MI 49719. Please make checks payable
to the Chamber of Commerce/Jersey Mud Run. *Last day to mail registration: 9/20/15..
First Name:___________________________ Last Name:____________________________ Age (race day):________
Address: ______________________________________ City: ___________________ State: _____ Zip: ___________
Email: ___________________________ Phone: ________________Gender: (circle one): M F Date of birth:_________
Emergency Contact: ________________________________ Emergency Contact Phone Number: __________________________
Shirt Men’s Sizes: (circle one) S M L XL (2XL additional $3). Youth sizes: S M L. *Shirts only guaranteed for pre-registered participants.
Entry fee: (circle one) Adults: $40 by 9/19, $45 9/21 -Race Day. Kids: $20. Teams (per individual):
$35 by 9/19, $40 9/21 - Race Day.
Teams: List names of all members: (Please mail registrations in together) _________________________________________________________________________________________________________
Waiver: I understand participation in this event is potentially hazardous, & I should not enter unless I am medically able & properly trained. In consideration of acceptance of entry, I assume full & complete responsibility for any injury or accident, which may occur while I am traveling to or from event, during event or while I am on the premises of event. I also am aware of & assume all risks associated with participation, including but not limited to falls, contact with other participants, effect of weather, traffic & conditions of the roads. I, for myself & my heirs & executors, hereby waive, release & forever discharge event organizers, sponsors, promoters, & each of their agents representatives, successors, & assigns, & all other persons associated with event, for all my liabilities, claims, actions, or damages that I may have against them arising out of or in any way connected with participation. I understand this waiver includes above parties to use photographs, videotapes, recording, or any record or the event. I hereby confirm that I am physically fit & qualified to participate in this event & I am at least 18 years of age or have had this release signed by my guardian if I have not reached the age of 18. I understand the entry fee is non-refundable & non-transferable.
Participant Signature: _________________________________________________________________Date: _______________
Parent’s Signature if under 18 years: ______________