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Appleby Family 5K or 2 Mile Walk
Randy Appleby, a teacher at Central, and his family have been dealing with a devastating disease. Susan Appleby, Randy’s wife, has been battling cancer since 2012. Since first being diagnosed, she has gone through many treatments, but in the last couple of years, the treatments are becoming less and less effective and she is running out of available options. Most recently, Susan’s cancer has shifted to her brain, to which she just underwent another surgery to contain this aggressive disease.

We are hosting a 5K Fun Run or 2 Mile Walk on Saturday, April 22 at Central High School. The run/walk will begin at 9:30 a.m. and there will be no formal awards or timing system. The cost to pre-register is $20 and you will be guaranteed a shirt if registered by Friday, April 7. You may also register on the run/walk day between 8:30 and 9 a.m.; all profit will go to the Appleby family.

To be pre-registered your registration form must be completed and received before Friday, April 7, 2017. Please make checks payable to CHS. Registration forms and money may be dropped off or mailed to:

Central High School
Attn: Melissa Bahnson
P.O. Box 38
Salem, WI 53168

Email address
First and Last Name
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Male or Female
Address
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City/State/Zip
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Phone Number
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Email (used to confirm registration)
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T-Shirt Size
NOTE: Shirts are provided to all pre-registered participants. Those registering onsite, April 22, are not guaranteed a shirt or correct size.
WAIVER
RELEASE STATEMENT (All participants must read and sign)
I have read the accompanying event information and understand the policies of the event. I know that running and walking a race is potentially a hazardous activity. I should not enter unless I am medically able and properly trained. I assume all risks associated with my voluntary participation in this event, including but not limited to, falls, contact with other participants, the effects of the weather, traffic, and all appreciated by me. Knowing these facts, and in consideration of accepting my entry, I for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, covenant not to sue and WAIVE, RELEASE AND DISCHARGE Central High School, the Town of Salem, all sponsors, race officials, successors or assigns for ANY AND ALL claims or liability, whether foreseen or unforeseen, for death, personal injury, or property damage arising out of it, or in the course of my participation in this event. I further grant full permission to the above mentioned sponsors, organizers and or agents authorized by them to use any videotapes, motion pictures, recordings or other record of the event for any reasonable purpose.
Signature of Participants
(Signature of Parent/Guardian if entrant age is 17 or under)
Electronic Signature
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