Haley’s Hearts Foundation’s
5th Annual Forever 5K Run/Walk
and Family Friendly One Mile
Saturday, September, 26, 2015

Parking and Start Line will be at Hartsville City Park. Entrance to Park is at the intersection of East Main

Race Start time is 9:00am. Race will take place Rain or Shine. Course has inclines and declines with a
Water Station along the way. Family Friendly one mile will begin after completion of 5K.

Pre-Registration cost is based off T-Shirt size per participant: Adult Size $30, Youth Size $20, Toddler $10.
Children age 5 and under are free unless a T-Shirt is desired. Deadline for Pre-Registration is Friday,
September 11, 2015. Race Day registrations will be accepted however cost will be $35.00 per participant
and a T-Shirt is not guaranteed. Registration the day of race will start at 7:00am.

Please fill out the form completely and return with payment to:
Haley’s Hearts Foundation
4455 Cedar Bluff Rd.
Lebanon, TN 37087

Money raised will be given to individuals/families that have incurred significant expenses due to illness
or death from Congenital Heart Defects (CHD) and Awareness of CHD. Haley’s Hearts Foundation is a
501 (c) (3) non-profit organization and your donation is 100% tax deductible.

Important Please Read
Waiver: In consideration of being allowed to participate in this event, I, for myself, executors, administrators, all persons listed above, and
child(if signing as a parent), do hereby release and promise not to sue the hosts, sponsors, or any cooperating agencies or employees for
any claims or injury that may result from my participation in said event. I know that these events are potentially dangerous, and I have full knowledge of all risks involved. I am physically fit and sufficiently trained in said event.

(If under 18, signature of Parent/Guardian is required)