Chaska River City Days 5K Run
Saturday, July 29, 2012
Participant's Name:
___________________________________________________________
Address:_____________________________________________________________________
City: _________________________________ State: ___________ Zip:
_________________
Phone: _______________________________ Email:
_________________________________
Date of Birth: _______________________ Age
on Race Date:
________
Gender: ___Male ___Female
WAIVER. My participation in the River City Run/Walk is at
my own risk, I release and discharge all claims for damages, personal injury,
illness or death-including those which may be attributed to weather conditions,
falls, contact with other participants, and condition of the roads and trails,
which I have or may occur as a result of my participation in this
event. This release is intended to discharge volunteers, officials, employees,
race directors, sponsors, and all others associated with this event from any and
all liability arising out of or connected with my participation in this event.
Signature: _________________________________________ Date:
___________________
Parent/Guardian (under 18) Signature:__________________________ Date: ___________
FEE for 5K Run: [ ] $20 (Received by July 13, 2012;
[ ] $23 (After July 13, 2012)
T-Shirt Information: __Small
__Medium __Large __XL
__XXL __XXXL
(T-Shirt to all paid pre-registerants as of the 07/13/12 deadline)
Race Timer: Apple Raceberry Jam