Gopher 5k Run Registration Form

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Gopher 5k Run Registration Form Powered By Docstoc
					                              Viola Gopher Count
                                            3rd Annual
                                      Gopher 5k Run

                          1.5 Mile Family Fun Walk
                                        Wednesday June 16th
                           5:00-6:00 PM Race Day Registration at Viola Town Hall
                                      Race starts approximately 6:15 PM

               (All Money Raised will go to the Eagles Cancer Telethon)

                                ****New run and walk routes this year****

                   Prizes: (Awards Immediately Following Race, under the Big Top)
                                             5K Run
                      $$Cash Prize Awarded to Top Female and Male overall$$
       Medals to top Male and Female in All Age Groups (12 and under, 13-19, 20-29, 30-39, 40-49, 50+)

                                          1.5 Mile Walk
                  Biggest Family Award (most participants that walk/run and are related!)

                $17.00 pre-registration or $20.00 day of the race --- T-Shirts available for all—
                             If you raise over $30.00 – Registration is waived

     Name____________________________- Age on June 16, 2010____-Gender M-F
     RACE: 5K or 1.5 Mile Walk (Family __________), T-shirt Size: S – M – L – XL
Waiver must be read and signed before mailing:
I know that running is a potentially hazardous activity. I should not enter or run this event unless I am
medically able and properly trained. I agree to abide by any decision of a race official relative to my ability
to safely complete the run. I assume all risks associated with running in this race including, but not limited
to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, the
conditions of the road and traffic on the course, all such risks being known and appreciated by me.
Having read this waiver and knowing these facts, and in consideration of your acceptance of my
application, I, for myself and anyone entitled to act on my behalf, waive and release the event, and all
sponsors, the Township of Viola, MN, their representatives and successors from all claims or liabilities of
any kind arising out of my participation in this event even though that liability may arise out of negligence
or carelessness on the part of the persons named in this waiver. All fees are nonrefundable .

Signature                                                                   Date
Parent's Signature if under 18
Checks payable: Viola Gopher Count
Send to: PO Box 1033, Eyota MN 55934
Contact for additional information: Jerry Wooner (507) 259 -7217 or website

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