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NAME: (Please Print)
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AGE:
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ADDRESS:
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CITY:
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STATE:
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ZIP:
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EMAIL:
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Please check one: ____ One Mile Run/Walk ____ 5K Run Gender: ____ Male ____ Female T-Shirt Size: ____ Children's L ____ Adult S ____ Adult M ____ Adult L ____ Adult XL WAIVER (Please read and sign): In consideration of my acceptance of this entry, I hearby, for myself, my heris, my executors, and administrators waive any and all rights and claims for damanges I may have against the sponsors, coordination gorups, and/or any individuals associated with the event, their representatives, successors, and assigns, and will hold them harmless for any injuries suffered in connection with said event. Also, none of the above are responsibile for the loss of personal items nor any other form of aggravation in connection with said event. I have been warned I must be in good health and prepared to participate in this physically demanding event. In filing out this form, I acknowledge I have read and fully understand my own liability and do accept the restirctions.
ENTRANT'S SIGNATURE:
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PARENT'S SIGNATURE: (Required if entrant is under age 18)
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Early registration form and checks, made out to Westminster Middle School can be mailed to: Westminster Middle School |