|
print in portrait format if possible 5 for the Kids Official Entry Form Name: _________________________________________________________________________________ Address:______________________________________________________________________________ City, State, Zip:_________________________________________________________________________ Phone:________________________________________________ email:________________________________________________________________________ @ ____________________________ Sex:_____________Age on Race Day:____________ Race Division (check one only): 5K Run _________ 5K Walk_________ Team Name: (Optional)______________________________________________________________-submit entries together Entry Fee: (check only one) ________$25 Race Day/Late Registration(Includes T-Shirt while supplies last) ________$55 Team Registration (includes 3 t-shirts and party) T-Shirt size: (circle one if applicable) S, M, L, XL Make checks payable to:
"5 for the Kids"" WAIVER: This waiver must be signed: in consideration of the acceptance of my entry, I hereby waive on behalf of my heirs, executors and assigns, all claims of any nature arising from my participation in the Dayton Bar Association's "5 for the Kids" run and do hereby release the Dayton Bar Association, Brixx Ice Company, Five Rivers MetroParks, Greg McCormick, and all sponsors, workers, officials and volunteers from any claim whatsoever arising from my participation in this event. I agree to abide by all the rules for participation and acknowledge that the Race Committee may refuse or return my entry at its discretion. I understand the risks for such a run and have trained adequately in preparation. I have noted any relevant medical conditions on this form. ENTRY SIGNATURE:________________________________________________________Date: __________________ Parent's Signature (if under 18): _________________________________________________Date: ___________________ Emergency Contact: ___________________________________________________________Phone___________________or put "AT RACE" Relevant Medical Condition ___________________________________________________________ |