Robbins Run, Walk, and Roll!
Event is scheduled for October 6, 2012
At beautiful Lowes Creek County Park Expo Center
5K Bike Tour
5K Fun Run and Walk
1/2 K Kids Robbins Rush!
This family event supports Robbins after-school Programs.
Your registration allows you to participate in any or all events!
7:00 A.M. Check-in and day-of registration opens 2012
8:00 A.M. 5K Bike Tour Starts
9:00 A.M. 5K Run/Walk Starts
10:00 A.M. Kid’s 1/2 K Robbins’ Rush
Receive a Robbins Run, Walk, and Roll 2012 t-shirt if registered by September 21, 2012!
Please fill out one registration form for each participant and return by September 21, 2012 to:
3832 East Hamilton Avenue
Eau Claire, Wisconsin, 54701
Fee: Adult: $20 includes a long-sleeve t-shirt Child (12 and under): $10 includes a short-sleeve t-shirt
*Participants may register up to the day of the event but will not receive a shirt if registered after
September 21, 2012.
Participant’s Name_________________________ Please check one: Adult_____ Child (12 and under)_____
Address: __________________________ City _______________ State ______ Zip _________
Phone _______________ Email: _____________________________________
If you would like to pass on the t-shirt and donate the entire registration fee please check here.______
T-shirt Size (please circle one): Youth: S M L ($10 ea.) Adult: S M L XL XXL ($20 ea.)
(Shirts will be available to be sent home with students by October 5th
or may be picked up at Robbins, after 4 PM by October 5th or at Registration on October 6, 2012 at Lowes Creek
Please make checks payable to Robbins PTO
If you would like to make an additional donation please include that amount here._____________
Total amount understand that participation in the (Checks made out to Robbins PTO/RWR)
Waiver & Release: I of payment included:______ Robbins Run, Walk and Roll is voluntary and involves an element of risk or danger for
participants and may cause serious injury, death, or property loss. I acknowledge these risks and release the County of Eau Claire, Robbins
Elementary, Eau Claire School District and any of the sponsors involved from any liability for injuries or damages sustained while participating in
the above activity.
I also grant permission for photos to be taken of my children or me during the event to be used by Robbins Elementary, the Eau Claire School
District, or other agencies for educational/public relations purposes.
Parent/Guardian Signature (if participant is under 18) _______________________________________
For additional information or questions please contact Don Perry at 715-852-4600 or email@example.com
This is a rain or shine event. Unfortunately, refunds will not be given.
For the safety of all participants, no pets please.