Sleigh Bells on the Square
December 9, 2006
OFFICIAL ENTRY FORM – PLEASE PRINT
Please Print All Requested Information:
Name:___________________________________________________ Age:_______ Male___ Female_____
Address:______________________________________________________________________________
Phone:___________________ Email:__________________________ T-shirt size M___ L___ XL___
School:_______________________________________________________________ Grade:____________
| Cost: $15.00 Early Registration, $20.00 after December 4, 2006, Phantom Runner: $15.00 (Support in Spirit and get a T-Shirt!) |
| In consideration of this entry and its acceptance, I waive any and all claims for myself (or minor child, if a participant) and my heirs against all of the officials, sponsors of the Sleighbells on the Square 5-K, including the Cobb Bar Association for any illness or injury received from participation. I further state that the participant is in proper physical condition to participate in this event. I give permission for the use of the participants name and/or picture in any public account for this event. I certify that I am 18 years of age or older or that I am the parent/guardian of the participant and am granting permission and executing this release on his/her behalf. |
Signature ______________________________________________
Parent/Guardian if under 18 _________________________________
Make checks payable to “Sleighbells on the Square 5-K”. Send entry form and registration fee to:
Sleighbells on the Square 5-K, c/o Pacesetter’s P.R., P.O. Box 817777, Atlanta, Ga. 30366.