2014 Forney Lions 5k Race and Family Fun Run ENTRY
Forney Lions 5k Information Page
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 September 1, 2014
| $25.00
|
| Late: after September 1, 2014
| $30.00
|
HOW DID YOU OBTAIN THIS FORM?
__ requested by mail
__ unsolicited mail
__ by FAX
x via the internet
__ other:_____________________
|
|
Make checks payable to:
Forney Lions Club
and mail to:
Forney Lions Club
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 UNDERSTOOD 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 # (___)_____________________________________________________________