October 23, 2010 Spirit Run Entry Form |
| _______________________ |
_______________________ |
| Last Name |
First Name |
| _______________________________________________ |
| Street Address |
| _______________________ |
____ _______________ |
City |
State Zip Code |
| _______________________ |
_______________________ |
| Age |
Birth Date / Age Group |
| _______________________ |
_______________________ |
| Phone # _________________________________________ |
| Email ___________________________________________ |
| Gender: (Circle One) Male Female |
| T-shirt (Circle One) S M L XL XXL |
| Race: (Circle One) 2K 5K 10K |
| Entry Fee: |
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$10.00 Pre-Registration-Children, must be received by Oct 16
$20.00 Pre-Registration-Adult, must be received by Oct 16
$25.00 Adults – race day
$15.00 Children (11-18) - race day
$10.00 Children (10 and under, Race day and Pre-Registered)
$10.00 All ages on the 2K
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All Proceeds go to Lake Cities Spirit of Christmas
Make Payable to Lake Cities Spirit of Christmas
Donations Welcomed
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| Mail Entry Form to: |
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Spirit of Chriatmas
P.O. Box 806
Lake Dallas, TX 75065
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All participants must read and sign the following waiver.
I acknowledge that running near automobiles and bicycles is extremely dangerous
and that running in the heat is an extreme test of a person’s physical and mental
limit and there exists the potential for death or serious injury. I certify that I am
physically fit, have sufficiently trained for this event, and have not been advised otherwise
by a qualified medical person. I also certify that I will drink plenty of water before, during
and after the event. I assume the risks of participation and assume full responsibility for
injury, accident, or illness, which may occur during the event or while I am on the premises
of the event and I hereby release and hold harmless the sponsors, promoters and all persons
and entities associated with the event, from any and all injury or damage whether it be caused
by negligence of the sponsors, promoters or other persons or entities associated with this
event or otherwise. Further, I hereby grant full permission to any and all of the foregoing
to use photographs, videotapes, motion pictures, recordings or any other record of this event.
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| ________________________________ |
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| Signature of Particpant (Parent's if minor) |
Date |
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