2013 Forney Lions 5k Race and Family Fun Run ENTRY NAME: Last______________________ First_____________________ Middle__________ ADDRESS: Street_________________ City_________________ State____ Zip________ HOME PHONE: (____) - ___________________ WORK PHONE: (____) - _______________ E-Mail:________________________________________________________________________ Date of birth:_______________________ AGE:____ Female:_____ Male:_____ ADULT T-THIRT SIZE: __ Small __ Medium __ Large __ Xlarge __ XXlarge __ XXXlarge YOUTH T-THIRT SIZE: __ Small __ Medium ENTRY FEE ENCLOSED: Postmarked on or before August 31, 2013 $20.00 Late: after August 31, 2013 $25.00 ______________________________________ | Make checks payable to: | HOW DID YOU OBTAIN THIS FORM? | Forney Lions Club | __ requested by mail | and mail to: | __ unsolicited mail | | __ by FAX | Forney Lions Club | __ via the internet | | __ other:_____________________ | P.O. Box 1332, Forney TX 75126 | | ForneyLions@Yahoo.com | | Form may be photocopied for | | additional applications | | | | * * NO REFUNDS * * | |______________________________________| * * WAIVER OF CLAIM BELOW MUST BE SIGNED * * WAIVER OF CLAIM Please read carefully, must be signed. In consideration of the acceptance of this registration entry, I the undersigned assume full responsibility for any injury or accident which may occur during my participation in the event or while I am on the premises of the event. I hereby release and hold harmless Forney Lions Club , City of Forney, the sponsors, the promoters, and all other persons and entities associated with the event, or their agents, employers, or otherwise. I will not enter and participate unless medically able and properly trained. I also know that although police protection will be provided, there may be traffic on the course route. I assume the risk associated with this event, including but not limited to, falls, contact with other participants, the effects of weather, and the conditions of the road. Fees are nonrefundable. T-shirt size is not guaranteed. I have read the foregoing and certify my agreement by this signature, and my parent's or guardian's signature if under 18 years of age. I HAVE READ AND UNDERSTAND ALL OF THE ABOVE. Signature:_______________________________________________________________ Date:____________________________________________________________________ Signature of Parent:_____________________________________________________ (If participant is under 18 years of age on the day of the event.) In case of accident call:_________________________________________________ Phone # (___)_____________________________________________________________