Judy Seifert - firstname.lastname@example.org
6th Annual 4-Man Scramble!
Info. to:email@example.com -
Payment by mail to:P. O. Box 2297 Lancaster, OH 43130
Place: Hocking Hills Golf Club & Urban Grille, Logan, OH 43130
Date: Wednesday, 9/21/22
Registration: 8:30-9:15 AM
Shotgun start: 9:30 AM
Cost: $60 per person, $240 per team
Cost includes: 18 holes of golf, cart, green fees & lunch (Pick up at the 9th hole & eat while you play)
Games, Door Prizes Drawing
Terms & conditions for dogs
In consideration of the acceptance of the entry and the holding of the event, I agree to hold Stephy’s House Women’s & Youth Crisis Center, a 501c3 incorporation, and the owners of the premises upon which this event is held, harmless from any claim for loss or injury to person, dog, or property. I personally assume all responsibility for any such claim.
I understand that my dog must be on a regular leash (no flex leashes) at all times, must wear their dog tags, and must be current on all of their vaccinations.
* Concession Stand - The Millersport, OH Sweet Corn Festival
Annual Millersport, OH Sweet Corn Festival Concession Stand
Place: Historic Lions Park Millersport, OH 43046
Date: Wedn. Sept. 1 -Sat. Sept. 4, 2021
Hours: 5-11:00PM: Sept. 1, 2, 3
11AM-11:00PM: Sept. 4
Cost: Taco-in-a-Bag $5 - Water/Pop $1
9th Annual 5K Walk/Run
Place: Fairfield County Fairgrounds, Lancaster, Ohio
(corner of Fair Ave. & High Street entrance)
Date: Sunday, 10/24/21
Race time: 3:00 P.M.
Registration on Race Day: 1:30-2:30 P.M. (located in the #50 red metal building)
Online Pre-registration fee : $30, includes t-shirt
Registration fee on race day: $35, includes t-shirt
Family package - kids walk free with parents. If you would like to purchase a t-shirt for children. They are $10 each (preregistration only)
Deadline for online registration: 10.15.21 @ 11:59 PM. - By mail, deadline: 10.15.21
Mail to: Stephy's House, P. O. Box 2297, Lancaster, OH 43130
Please print legibly and fill out separate registration form for each participant.
Gender: O Male O Female
Age on Race Day ________
Emergency Contact on Race Day (name and phone number) _________________
INDICATE T-SHIRT SIZE
O Youth Small
O Youth Medium
O Youth Large
O Adult Small
O Adult Medium
O Adult Large
O Adult X-large (add $1)
O Adult XX-large (add $2)
O Adult XXX-large (add $3)
Register On-line at: active.com OR Enclose registration form with your payment of $30 made payable to Stephy’s House annual 5K and mail to:
Stephy’s House 5K
P. O. Bos 2297
Lancaster, OH 43130
Course-grass, hills, asphalt
Parking-grassy area of fairgrounds (signs will direct you)
*Vendors located inside of red metal building
• Sunday, OCTOBER 24, 2021 (Read before signing)
I know that participation in this event is a potentially hazardous activity. I will not enter and participate unless I am medically able and properly trained. I agree to abide by any decision of any race official as to my ability to safely complete the event. I assume all risks associated with this event, including but not limited to falls, contact with other participants, effects of weather including high heat and humidity, traffic and the condition of the road/trails, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the city of Lancaster, Ohio, Fairfield County Fairgrounds, Stephy’s House Inc., race officials, volunteers, and all sponsors from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purposes. I know that leashed dogs, with shots up-to-date and baby strollers, baby joggers are allowed on the course.
Signature of Athlete (Parent’s signature if under age 18 years of age) ________________________________________________________ Date______________
Stephy's House is not a shelter. We are a command center, for victims of abuse, to find the tools, contacts and information, to empower victims to become survivors.
Mission Statement: We are committed to investing with victims of abuse, in their journey, to a violence-free life.
24/7 Help Line 740.823.2000
About This Activity
Stephy’s House is named after Stephanie J. Seifert, who (@ the age of 39 and only 5 months after her dissolution) was brutally beaten and murdered by her former husband in Lancaster, Ohio on October 23, 2012. It was a horrific double murder-suicide that rocked the city of Lancaster and also took the life of veteran police officer, Randy Bartow, Stephy's friend who was visiting.
Stephy’s House is a crisis center for women and youth who are victims of domestic violence; with our emphasis on educating the public of the national epidemic of domestic violence.