Herding for a Healthy Heart

A 5K Run/Walk Hosted by The Bedford High School Key Club

Benefitting Owen Taylors Medical Fund

Date: Saturday, September 28, 2013 Start Time: 9:00 AM Location: Shawnee State Park, Schellsburg, PA Registration: Boat Launch Parking Area 5K Individual Run, 5K Team Run, 5K Walk, Lollipop* *Lollipop race is for children 6 and under, there is no charge for this event with an adult registration. Join us afterwards for awards, door prizes, and refreshments!
TROPHIES: 5K Run Overall Winner: Male and Female 5K Run Winning Team COURSE INFORMATION:
COURSE IS ONE LOOP ON THE BEAUTIFUL LAKE SHORE TRAIL--CINDER TRAIL WITH A FEW MODERATE HILLS PLENTY OF PARKING AT THE BOAT LAUNCH PARKING LOTS RESTROOMS AVAILABLE RACE PACKET PICK-UP WILL BE AT THE REGISTRATION TENT BETWEEN 7:30 AND 8:45 AM ON RACE DAY.

Owen has a rare congenital heart condition called congenitally corrected transposition of the great arteries along with an Atrial Septal Defect, Pulmonary Stenosis, and an Ebsteins malformation of his tricuspid valve. This condition only occurs in 0.5% 1% of all children born with congenital heart defects. He has had 2 heart surgeries so far:
In August 2012 Owen developed complete heart block due to his heart condition and had surgery to implant a biventricular pacemaker. On July 1, 2013 Owen had his second heart surgery to place a band around his pulmonary artery to try to build the muscle in his left ventricle.

And faces his third:

When the doctors feel his heart is strong enough and ready, he will undergo a third heart surgery called the double switch to correct the flow of his heart and close the hole between his upper chambers.

Herding for a Healthy Heart Registration Form

Entry Fees are Non-refundable Early Bird (until September 12) Guaranteed Shirt! $18 Individual $40 Family RegistrationNote: Familyparents and children living in the same household, and children under the age of 18. $75 Team RegistrationTeam of 5 Regular Registration (until September 25): $20 Individual $50 Family Registrationas described above $85 Team RegistrationTeam of 5 Procrastinator (after September 25): $25 FAMILIES AND TEAMS MUST SEND THEIR REGISTRATION AND COMPLETE PAYMENT FOR EVERY MEMBER IN THE SAME ENVELOPE! Checks should be made payable to Bedford High School Key Club Mail registration forms to Bedford High School Key Club, C/O Bedford High School, 330 E. John St, Bedford, PA 15522
Name: ______________________________________________ Please Check Race Category: _____ 5K Individual Run _____ 5K Team Please Check Team Category (if applicable): _____ Male _____ Female _____ MIXED Run ______5K Individual Walk _______5K Team Walk _____ Lollipop

TEAM NAME: ______________________________________________ OTHER TEAM MEMBERS:

Street Address: ______________________________________________ City: _______________________ State: ______ Zip Code: __________ Date of Birth: ______________ Age on Race Day: __________ Gender: MALE FEMALE T-Shirt Size: S M L XL other: _____ (NOT AVAILABLE FOR LOLLIPOP RACERS!) Email Address: _______________________________________________Phone Number: _______-_______-__________

Waiver: In submitting this entry, I, intending to be legally bound for myself, my heirs, executors and administrators

waive, release, and forever discharge the Bedford School District, the Bedford High School Key Club and all event sponsors, event volunteers, and workers and their officers, directors, agents, successors, and/or assigns for any and all injuries suffered by me at this event. I understand I am physically fit and prepared for this event. I understand that the above individuals and organizations are not responsible for any and all injuries, expenses, with regard to my participation in this event. It is also my understanding that said event does not carry insurance and that I (or my parents) am personally responsible concerning this matter. I understand I may be photographed and agree to allow my photo, video or film likeness to be used for any legitimate purpose by any of the aforementioned parties.

_________________________________________ Date: ___________ _____________________________________ Signature of Participant Signature of Parent (If Participant is under the age of 18)